Manage Cancer Care While Reducing Financial Toxicity

Providers who treat patients with cancer have a monumental task of staying up to date on new therapy regimens. Each year additional treatments fill the pipeline — 20 new oncology drugs were approved in 2020 alone.https://www.beckershospitalreview.com/oncology/20-cancer-drugs-approved-in-2020.html Approvals for drugs to treat patients with cancer account for more than a quarter of new treatments since 2010.https://ascopost.com/news/september-2019/cancer-drugs-account-for-over-a-quarter-of-all-new-drug-approvals-in-the-us/ An increase in available oncology treatments has increased the patient survival rate from 49 percent in the 1970s to around 69 percent between 2007 and 2013.OurWorldinData.org

Yet managing oncology remains a top challenge in health care. Cancer is the second leading cause of death in the United States.https://doi.org/10.3322/caac.21551 Costs associated with cancer are expected to rise about 30 percent to nearly $246 billion by 2030, making it a challenging and expensive disease to manage.https://ascopost.com/news/june-2020/national-cost-of-cancer-care-in-the-united-states-expected-to-rise-to-over-246-billion-by-2030

Each cancer treatment journey is unique to the individual due to customized disease management. The array of oncology treatments, such as chemotherapy — infusion or oral drugs, radiation, targeted drug therapy and surgery, plus managing any preexisting conditions, adds layers of complexity to the journey. More difficulties occur when complications arise from the type of cancer, the stage of diagnosis, the treatment regimen, the patient's response to treatment or even the patient's ability to afford treatments.https://www.cancer.net/navigating-cancer-care/how-cancer-treated Often the financial impact of cancer creates problems for the patient.Loren Collado and Isaac Brownell (2019) The crippling financial toxicity of cancer in the United States, Cancer Biology & Therapy, 20:10, 1301-1303, DOI: 10.1080/15384047.2019.1632132 Those with cancer experience nearly four times higher expenditures annually than a patient without cancer.Park J, Look KA. Health Care Expenditure Burden of Cancer Care in the United States. Inquiry. 2019;56:46958019880696. doi:10.1177/0046958019880696 Such costs add up with cancer patients being 2.65 times more likely to declare bankruptcy than those without cancer.Ramsey S, Bansal, A, Fedorenko C, Blough D, Overstreet K, Shankaran V, and Newcomb P. Financial Insolvency as a Risk Factor for Early Mortality Among Patients With Cancer. Journal of Clinical Oncology 2016 34:9, 980-986. Financial insolvency has major implications for patient mortality.Ramsey S, Bansal, A, Fedorenko C, Blough D, Overstreet K, Shankaran V, and Newcomb P. Financial Insolvency as a Risk Factor for Early Mortality Among Patients With Cancer. Journal of Clinical Oncology 2016 34:9, 980-986.

Health plans and payors must support balance and help manage all aspects of the disease while trying to manage costs. Along the way, patient cost concerns and therapy complications may unintentionally create gaps in cancer care.

This includes supporting each treatment stage and the providers selecting those treatments to help manage costs and eliminate waste throughout, while moving patients to high-quality, lower-cost sites of care. We recommend applying preferred drug strategies across benefits and site-of-care optimization.

Patients require care coordination as they navigate this disease and its complex treatments. Frequent touchpoints and data sharing can drive better patient outcomes and experience as well as cost savings.

Comprehensive care management should be introduced even before a patient's first treatment to establish an early, strong relationship that supports patient decision-making and access to resources. This care also helps patients navigate through the disease journey, including post-acute and supportive care options. Establishing an advance directive early can help reduce financial toxicity; in fact, according to National Center for Biotechnology Information, $2,280 savings per patient are associated with establishing early supportive care.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4550689/ Additionally, planning for advanced care is associated with improved quality of life and survival in patients.Bischoff, K. E., Sudore, R., Miao, Y., Boscardin, W. J., & Smith, A. K. (2013). Advance care planning and the quality of end-of-life care in older adults. Journal of the American Geriatrics Society, 61(2), 209–214. https://doi.org/10.1111/jgs.12105.

Designing and implementing the right strategies to support oncology helps lessen the financial burden, while helping manage the complicated cancer journey.

Aligning to find the right solution helps to address complications and gaps in cancer care for plan members and their providers.