Out-of-Pocket Spending for Cancer Medication, Financial Burden, and Cost Communication with Oncologists in the Last Six Months of Life in Israel

Honest communication between oncologists and patients is important in alleviating the financial burden of cancer care. This study explored patient–relative–oncologist communication regarding the affordability of out-of-pocket (OOP) medication and the extent to which this communication addresses itself to the families’ financial burden. A cross-sectional survey was conducted among primary caregivers of deceased cancer patients. About 43% of relatives said that they and/or the patients had paid out of pocket for medications during the last six months of the patient’s life. Most (73%) oncologists suggested an OOP medication without asking about financial ability, 43% hardly explained the advantages of an OOP medication, and 52% hardly explained any treatment alternatives. Older age and female gender were related to less communication about an OOP medication, and better education, greater affluence, and having private health insurance were related to more communication. About 56% of relatives said that OOP payment for medications inflicted a very heavy or heavy financial burden on patients and their households. Physicians’ interest in financial ability and giving explanation lightened the burden. Given the difficulty of explaining the complex interactions of cost and clinical outcomes, oncologists need to be better educated in skills that would enable them to communicate costs more openly and should consider the cost of a treatment when prescribing it.

Navigating the high costs of cancer care: opportunities for patient engagement

Over the past decade, the financial burden of cancer care on patients and their families has garnered increased attention. Many of the potential solutions have focused on system-level interventions such as adopting value-based payment models and negotiating drug prices; less consideration has been given to actions at the patient level to address cancer care costs. We argue that it is imperative to develop and support patient-level strategies that engage patients and consider their preferences, values and individual circumstances. Opportunities to meet these aims and improve the economic experience of patients in oncology are discussed, including: shared decision-making and communication, financial navigation and treatment planning, digital technology and alternative care pathways, and value-based insurance design.

All Men Are Created Equal: Addressing Disparities in Prostate Cancer Care

The global cancer burden is estimated to have risen to 18.1 million new cases and 9.6 million deaths in 2018. By 2030, the number of cancer cases is projected to increase to 24.6 million and the number of cancer deaths, to 13 million. Global data mask the social and health disparities that influence cancer incidence and survival. Inequality in exposure to carcinogens, education, access to quality diagnostic services, and affordable treatments all affect the probability of survival. Worryingly, despite the fact that many cancers could be prevented by stronger public health actions and many others could be largely cured by better access to diagnostics and affordable treatments, the international community has yet to make a substantial move to tackle this challenge. In prostate cancer, studies show that there are geographic and racial/ethnic distribution differences as well as a number of other variables, including environmental factors, limited access to standard cancer treatments, reduced probability to be included in trials, and the financial burden of cancer treatments. Financial burden for the patients can result in poor adherence, increased debt, and poor long-term outcomes. The following article will discuss some of the important causes for disparity in prostate cancer and prostate cancer care, focused on the current situation in the United States, as well as possible remedies to address these causes.