The Annual Report to the Nation’s Special Topic describes the patient economic burden of cancer care in the US. The report, appearing in JNCI: The Journal of the National Cancer Institute, is the most comprehensive examination of patient economic burden to date and includes information on patient out-of-pocket spending by cancer site, stage of disease at diagnosis, and phase of care. The researchers used data from linked SEER-Medicare for patients 65 and older and the Medical Expenditure Panel Survey (MEPS) stratified by ages 18-64 and 65+ to estimate net costs of care.
Cost of Cancer Care by Cancer Site
In 2019, national out-of-pocket costs were highest for breast ($3.14 billion), prostate ($2.26 billion), colorectal ($1.46 billion), and lung ($1.35 billion) cancers, reflecting the higher prevalence of these cancers.
Cost of Cancer Care by Stage of Disease at Diagnosis
Cost of Cancer Care by Phase of Treatment
Researchers also compared patient economic burden by phases of treatment:
- initial phase, the first 12 months after diagnosis
- end-of-life phase, the 12 months before cancer death
- continuing phase, the time in between the initial phase and end-of-life phase
The initial phase of care had the next highest estimate, at $2,200 per year. The continuing phase of care was least expensive, at $466 per year.
Some cancer types had even higher patient costs. Patients with acute myeloid leukemia had out-of-pocket costs of $7,039 for the end of life phase, $6,093 for the initial phase of care, and $1,056 for the continuing phase. Patients with brain cancer had out-of-pocket costs of $5,901 for end-of-life care and $5,751 for the initial phase.
Cost of Cancer Care by Age Group (18-64 years and >65 years)
Researchers used two measures to calculate net patient cost of cancer: out-of-pocket expenses and time costs. Out-of-pocket costs include both fees for medical services as well as prescriptions. Time cost is the amount of time spent receiving medical care (including travel time) instead of pursuing work or leisure activities.
The annualized patient out-of-pocket cost was higher for patients aged 18-64 years than it was for those 65 or older. The younger age group also had higher time costs. Among both age groups, patients diagnosed within the past two years had the highest time costs.
“In the modern era of cancer research, we have to think about treatment costs and how they impact our patients. As exciting and promising as cancer research is, we are keenly aware of the issue of financial toxicity for these patients. Therapies that are highly effective are no doubt good news, but if they are unaffordable, it is not the total kind of progress we would like to see,” said Norman E. “Ned” Sharpless, MD, Director of the National Cancer Institute, of the National Institutes of Health. “Finding ways to ensure that not just some, but all patients get access to therapies that are beneficial to them is an important goal we must continue to strive for in the cancer community. This report will help guide us toward achieving that goal.”