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'Major Financial Hardship' Hits Most Patients Battling Advanced Colon Cancer

THURSDAY, May 28, 2020 (HealthDay News) -- A cancer diagnosis can deliver a double blow -- along with dealing with a serious health crisis, you also need to worry about how your treatment is going to affect your finances.

Nearly three out of four people with advanced colon cancer that spread to other parts of their bodies experienced major financial hardships within a year of starting treatment, a new study found.

"Major financial hardship was extremely common -- nearly 75% in a year experienced a decline in income, increasing debt, new loans, or selling or refinancing their home," explained study author Dr. Veena Shankaran. She's co-director of the Hutchinson Institute for Cancer Outcomes Research at Fred Hutchinson Cancer Research Center in Seattle.

Shankaran said she was surprised by how pervasive the financial woes were, but only to some extent. "These major financial hardships were higher than what we have observed in the past, but costs are increasingly being shifted to patients," she noted.

There has been an increasing awareness of the "financial toxicity" associated with cancer care, Shankaran said. In this study, the researchers wanted to get a better understanding of exactly how cancer care affects patients' overall financial health.

The study included 380 people undergoing treatment for advanced colon cancer that had spread to other areas of the body (metastasized). Their average age was 60. They were recruited from 126 centers across the United States.

Most of the patients were white (78%) and 61% were male. Nearly all (98%) were covered by health insurance.

The researchers asked about major financial hardships at three, six, nine and 12 months after treatment started. They asked about debt, new loans, whether someone refinanced or sold their home, and whether or not they had lost 20% or more of their income.

Financial woes increased at each time point. For example, at three months just 2% of these advanced colon cancer patients had lost 20% or more of their income. By six months, that number had risen to 7%, and at nine months, 12% had suffered a significant loss of income. At the 12-month mark, 27% had lost a fifth or more of their income, the findings showed.

At the start of the study, 19% had debt. By 12 months, nearly 57% had some debt. The rate of new loans, home refinancing and selling a home all rose during the study period.

Shankaran said the situation may be even more dire for patients who don't have insurance. The researchers did find that patients with lower income and lower asset levels were more likely to have major financial hardships.

She said that treatment for advanced colon cancer may be more costly, but that costs are likely a concern in other types of cancer treatment.

Another study found that young breast cancer patients struggled financially after their diagnosis -- even if they had insurance. That study was published recently in the journal Cancer Epidemiology, Biomarkers and Prevention.

Shankaran said the researchers don't know what specific aspects related to cancer care led to money troubles.

Robin Yabroff, senior scientific director for health services research at the American Cancer Society (ACS), said costs are probably a concern for most cancer patients.

"In my opinion, I think many patients are probably surprised by costs. Conversations about out-of-pocket costs to the patient are pretty infrequent," she said, noting that an ACS study found that just one in four cancer patients discussed out-of-pocket costs with their doctor.

"Out-of-pocket costs are increasing. There is increasing cost-sharing for those with insurance. They may be responsible for 20% to 30% of the list price of treatment," she explained.

Yabroff said it's crucial that patients are made aware of potential financial concerns ahead of time. Many people will lose time from work and income, and it may not just be the cancer patients -- spouses, parents and adult children may lose time from work, too. It's also important to find out how your health insurance will be affected if you have trouble returning to work.

Yabroff said these discussions can be with doctors, financial navigators and social workers. Along with letting you know what to expect, they can also let you know about any resources that might be available to help you.

"This study shows the importance of having these conversations. Three out of four people experienced a major financial hardship within 12 months. Cancer centers need to have these conversations with all patients, even those that may not appear to have any financial disadvantages. The advantage of having universal discussions is that you don't stigmatize anyone. Ideally, we want patients to be focused on their treatment and recovery," Yabroff said.

The study was part of the virtual annual meeting of the American Society of Clinical Oncology. Findings from meetings are typically viewed as preliminary until they've been published in a peer-reviewed journal.

More information

Read more about cancer costs from the American Society of Clinical Oncology.

SOURCES: Veena Shankaran, MD, co-director, Hutchinson Institute for Cancer Outcomes Research, associate professor, public health, associate professor, clinical research, Fred Hutchinson Cancer Research Center, and associate professor, division of medical oncology, University of Washington, Seattle; Robin Yabroff, PhD, senior scientific officer, Health Services Research, American Cancer Society; May 29-31, 2020, American Society of Clinical Oncology virtual meeting

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