A cancer diagnosis can feel like an overwhelming challenge—not just in terms of health, but also financially. For many patients, the initial phase of diagnosis requires multiple tests, specialist consultations, surgeries, pathology, and imaging services. Depending on the cancer’s location, stage, and any spread to other organs, additional tests like molecular diagnostics or ancillary treatments may be necessary. Even with good insurance, this process can be daunting; for those without insurance, it can feel near impossible.
The Financial Impact of Cancer Care: A Multilayered Burden
I’ve seen firsthand how the complexity of cancer care can impose significant financial hardships on patients and their families. In my practice, many patients’ cancer is discovered during an acute event that leads them to the emergency department. They’re admitted, treated, and connected with social workers and financial counselors. However, the financial burden often intensifies once patients transition to outpatient care.
Most cancer treatments, follow-ups, and long-term management occur in an outpatient setting once the patient is stable. This shift often results in high out-of-pocket costs, even for those with insurance. For uninsured patients, the financial toll can become unsustainable, leading to difficult decisions, emotional stress, and even bankruptcy. This is what we call “financial toxicity”—the financial strain experienced while navigating cancer care.
Financial Counseling and Support: A Lifeline for Patients
For uninsured or underinsured patients, financial counseling and support services are vital. Social workers help connect patients to financial aid programs and assistance unique to their state or city. This can alleviate some of the immediate costs, but outpatient care, where the bulk of cancer management occurs, often lacks the same level of financial support.
Outpatient treatments, labs, imaging, and follow-up appointments quickly accumulate, and costs can be unpredictable. Patients often face a patchwork system of billing that can further compound the stress of their diagnosis. Without a robust support system in place, many patients struggle to manage their care and the associated financial burden.
The Challenge of Cost Transparency and Coordination
One of the most significant challenges patients face is the lack of transparency in medical costs. Many patients receive little to no information about the price of treatments, medications, or diagnostic tests upfront. This uncertainty can compound the stress of an already overwhelming situation.
For insured patients, understanding what their policy covers, which providers are in-network, and how much they are responsible for paying can be complicated. Often, patients are left with surprise bills, unsure how to navigate their financial responsibilities.
Practical Strategies to Reduce Financial Toxicity
As healthcare providers, we play a crucial role in not only managing the clinical aspects of cancer care but also helping patients mitigate their financial strain. Here are some practical strategies I use with my patients:
- Prescribe generics whenever possible: Generic medications can significantly reduce costs, especially for long-term treatments. Always ask your oncologist if a generic option is available.
- Avoid unnecessary tests or treatments: A multidisciplinary tumor board review can help streamline care, ensuring that only necessary, evidence-based treatments are pursued. This helps avoid costly interventions with minimal clinical benefit.
- Review consensus guidelines at ASCO’s “Choose Wisely”
- Leverage existing imaging and lab tests: Encourage patients to use imaging or lab work done at other facilities. A CT scan done elsewhere is often just as valid as one performed at a specialized cancer center, saving the patient from redundancy and extra costs.
- Facilitate appropriate discontinuation or deescalation of systemic treatment when and where appropriate
- Be mindful of where services are performed: Costs for the same test can vary widely depending on where it’s done. Encourage patients to choose facilities that provide quality care at a lower cost.
- Understand your insurance coverage: Encourage patients to fully understand their insurance policy, including what is covered, which providers are in-network, and whether prior authorizations are required for specific services. This helps avoid unexpected out-of-pocket expenses.
A Collaborative Approach to Financial Care
Addressing financial toxicity requires a team approach. Oncologists, surgeons, social workers, financial counselors, and insurance coordinators must work together to help patients navigate the financial complexities of cancer care.
Care coordination can play a significant role in reducing unnecessary costs. Streamlining services, advocating for cost-effective treatment options, and ensuring transparent communication about the costs involved can help minimize financial stress for patients. Most importantly, patients should feel empowered to ask their healthcare team about less costly alternatives, generic medications, and support programs that may ease their financial burden.
Cancer care is complex, but with the right support and guidance, financial toxicity doesn’t have to be another source of stress. By focusing on cost transparency, coordinated care, and proactive financial counseling, we can help patients focus on what truly matters—their health and well-being.
About the author
Dr. Sajeve Thomas is a distinguished medical professional and a compassionate guide in the field of oncology. With over a decade of dedicated experience as a board-certified medical oncologist/internal medicine specialist, Dr. Thomas has become a trusted expert in the treatment of melanoma, sarcoma, and gastrointestinal conditions. Currently practicing at the renowned Orlando Health Cancer Institute, he brings a wealth of expertise to the complex and challenging world of oncology.