Costs of Cancer Treatment: the elephant in the examining room

  • 24 January 2014


Just as oncologists don’t like to bring up intimacy issues or spiritual matters with their patients, these same doctors are not particularly eager to discuss financial aspects of treatment. A 2007 article in the Journal of Clinical Oncology presents the results of a survey conducted by the authors at Sloan Kettering. They conclude that miscommunication between doctor and patient is likely due to doctor reluctance to raise the subject.  I doubt the results would be any different some seven years later.

Let’s face it: financial planning is not a sexy topic for most of the doctor populace. In fact, I believe many patients would guess that if they brought up the issue, their oncologist would refer them to a specialized staff member. After all, oncologists are trained in the science of treating cancer, not socioeconomic predictors.  Add to this the limited time an oncologist can spend with a patient, and I see a perfect storm.

Still, treatment affordability looms particularly large among stage IV breast cancer patients like me. After receiving such a diagnosis–an off-the-charts shock to the body–we are told that our cancer is treatable, not curable (if our type of cancer is indeed treatable). And while the cancer may respond to drugs, we don’t immediately ask how much these miracle meds will cost us out-of-pocket. We have more urgent questions on our minds: survival odds, side effects, and range of options. Money matters end up as background noise, to be investigated later after the initial shock has worn off, and best left to the experts in the insurance industry and the financial gurus at the hospital.

Both the oncologists with whom I have interacted did not discuss my finances. The one who delivered the unwanted diagnosis told me if he had the resources, he would choose to drive the 430 miles round trip to get cutting-edge treatment at a leading hospital. He did not ask me if my insurance would cover that hospital or if I had resources to travel that far and that frequently. But he did give me the option of getting standard-of-care treatment at a local hospital.

Fortunately, I had the resources and friends in the area where the leading hospital is located. Fortunately, that hospital happened to be an in-network provider in my PPO and paid major costs after my deductible and maximum out-of-pocket costs were reached. Fortunately, I qualify for a clinical study where I get the drugs free of charge, although insurance picks up the costs of constant blood tests, regular and frequent scans, and nurses’ and doctor’s labor and supplies. Those are fortunate circumstances that come together for a trifecta in my case. But even this “trifecta” isn’t perfect as I struggle to continue with frequent and long drives, causing wear-and-tear on the body as well as the car.

The hope is that the Affordable Care Act will help with this financial gap, but it may not cover providers in major areas that offer expensive care and clinical trials that local hospitals can’t. Time will tell if stage IV cancer patients will benefit in general from the new law.

In the meantime, resources exist to help those who are drained and stressed out by financial trauma, such as:

Patients deserve to have their financial concerns addressed. It’s stressful enough to get a cancer diagnosis, without adding money matters to the mix. As more doctors become aware of this issue, I believe change will happen. As with most things, it starts with education.

If you or a loved one has had cancer, did the oncologist(s) address the financial aspects of treatment with you? If so, what did they recommend?