Moving Proactively to Address Cost Concerns With Patients


There's another type of toxicity that physicians and nurses should watch out for. But this one is harder to spot and can affect the patient even after treatment has stopped.

Yousuf Zafar, MD, MHS

There’s another type of toxicity that physicians and nurses should watch out for. But this one is harder to spot and can affect the patient even after treatment has stopped.

According to a recent study, nearly half of patients diagnosed with colorectal or lung cancer reported that they had a hard time paying the bills on their household income.

The study, published in the Journal of Oncology Practice, adds to ongoing research at Duke Medicine that has explored the issue of “financial toxicity” from cancer care and whether costs can affect a patient’s outlook and outcomes.

“Our focus has been on how the cost of cancer care impacts a patient’s well being, and we found that patients are at risk of experiencing financial harm as a result of the treatments we prescribe,” said Yousuf Zafar, MD, MHS, associate professor at Duke and lead author of the study, said in a statement.” Even for patients who have insurance, those out-of-pocket costs add up."

It’s these costs that can lead to what researchers call “financial toxicity,” which can impact patients regardless of income, employment, the status of their cancer and other health problems.

The findings of this study were based on self-reported surveys and medical record data for 1000 patients who had been diagnosed with colorectal or lung cancers at five healthcare systems in the United States. Of those patients, 889 were cancer-free, while 111 had advanced cancers.

The study showed that a high financial burden was linked with a poorer health-related quality of life. In turn, the data also showed a relationship between patients’ quality of life and their perceptions of the quality of the care they received.

There is also a possibility that patients feeling the pressure of paying their bills may cut back on their treatment in order to make ends meet, Zafar said.

“Patients are at risk for not adhering to their treatments due to cost,” he said. “They may have to borrow, spend their savings, or cut back on basics like food and clothing, all to help pay for care.”

It has also been shown that cancer patients are unlikely to discuss out-of-pocket costs with doctors because patients often worry that simply mentioning strained finances could result in a lower quality of care.

“Financial toxicity is potentially harming our patients," Zafar said. "Without a doubt, we have our patients’ best interests in mind, so if we become more cognizant of that, we’re more likely to act on it.”

Zafar said he plans on continuing research on financial toxicity, but these results alone should prompt discussion among providers on how to cut out-of-pocket costs for treatments.

One way is to ask a pharmacist to run expensive prescriptions through patients’ insurance plans before sending the patient to the pharmacy, he said.

"We as physicians don’t bear the burden of finding the answer on our own,” Zafar added. “We might not have all the answers on how to decrease our patients’ costs, but we have people around us—pharmacists, financial advisors, social workers — who are just a phone call away."


Zafar SY, McNeil RB, Thomas CM, et al. Population-based assessment of cancer survivors’ financial burden and quality of life: a prospective cohort study [published online ahead of print December 16, 2014]. J Oncol Pract.

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