The Obama administration wants to advance cancer care--but how will patients pay for it?
The use of the term "moonshot" is both a little puzzling and sad. We last visited the moon nearly 45 years ago, and we began planning the project 55 years ago. "Moonshot" is so little used these days that it's virtually archaic.
That term in the context of treating cancer is also misleading: It suggests that the current initiative is not only an all-or-nothing proposition, but that work on the goal had not previously commenced. When the U.S. began preparing to travel to the moon, most forms of cancer were death sentences. Just in the past 25 years, the death rates for lung, prostate, breast, colon and stomach cancer have all dropped significantly. The five-year survival rate for renal cancer is up by nearly 50 percent from the 1970s. For leukemia, it's up about 80 percent. A third of prostate cancer patients died within five years of diagnosis 40 years ago; now virtually all survive. And while the five-year survival rate for esophageal cancer is only 18 percent, that's still quadruple the rate of the 1970s.
A mostly forgotten artifact of the "moonshot" was its absolutely stupendous cost--$25 billion in mid-1960s dollars, or nearly $200 billion today. The romance of trying to make it to the moon mostly overshadowed the criticism about its pricetag (the much higher cost of the Vietnam war helped as well). By contrast, the Obama administration is asking Congress for a much more modest $1 billion over two years to fund its cancer moonshot.
But the use of the "moonshot" term does help illustrate that this new push to defeat cancer seems to overlook the fact that progress made fighting the disease often creates a financial burden for its patients.
This has been borne out in a myriad of ways, particularly the cost-shifting by insurers that often leave even covered cancer patients with six-figure medical bills--and the fact many cancer survivors face a lifetime of follow-up care and its attendant costs.
But perhaps the most sobering evidence of missing the forest for the trees is a new study that appeared last week in the Journal of Clinical Oncology. Its findings were sobering: If cancer patients filed for bankruptcy, their mortality rate was 80 percent higher than patients who were in better financial shape.
The study was performed by researchers at the Fred Hutchinson Cancer Research Center in Seattle. Scott Ramsey, M.D., director of the Hutchinson Institute for Cancer Outcomes Research and the study's lead author, issued a succinct statement about the bankruptcy factor: "That blows away the benefits of many, if not most, treatments," he said. "To me, it's one thing if you go bankrupt. Financially, you're really in bad shape but you come out of it with your cancer treated. But if it actually is a double hit, where your very survival is affected? That is profound."
Only about 3 percent of cancer patients actually file for bankruptcy. But that apparently is far higher than the nationwide average. A 2013 study conducted by Ramsey concluded that cancer patients were 2.5 times more likely to file for bankruptcy than those who were cancer-free.
In other words, there is a significant subset of Americans who are more likely to die from cancer because they can't afford to pay for their treatment.
Hospitals could play some role in easing the pain of cancer care, such as being more quick to write off charges for insured patients, or offering very flexible long-term payment plans (think 10-20 years at no more than 1 or 2 percent interest, with applications for forgiveness if a patient's financial situation deteriorated). Instead, there seem to be more stories along the lines of Sean Recchi, one of the subjects of Steven Brill's 2013 Time magazine article "Bitter Pill." Diagnosed with non-Hodgkin's lymphoma, MD Anderson Cancer Center refused to treat Recchi until it received nearly $85,000 upfront, despite the fact that he had insurance.
It's good to see that the Obama administration, which has played a role in expanding health coverage second only to the creation of Medicare, wants to fight cancer more aggressively. But without more financial protections in place for patients, it could be a fight that scores relatively few blows. – Ron (@FierceHealth)
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