Financial Toxicity is Hurting my Cancer Patients


As news of Tom Brokaw’s cancer diagnosis spreads, so does his revelation that his cancer treatments cost nearly $10,000 per day. In spite of this devastating diagnosis, Mr. Brokaw is not taking his financial privilege for granted.  He is using his voice to bring attention to the millions of Americans who are unable to afford their cancer treatments.

My patient Phil is among them. At a recent appointment, Phil mentioned that his wife has asked for divorce. When I inquired, he revealed a situation so common in oncology, we have a name for it: Financial Toxicity.  This occurs when the burden of medical costs becomes so high, it worsens health and increases distress.  

Phil, at the age of 53, suffers with the same type of bone cancer as Mr. Brokaw.  Phil had to stop working because of treatments and increasing pain. His wife’s full time job was barely enough to support them. Even with health insurance, the medical bills were mounting. Many plans require co-pays of 20 percent or more of total costs, leading to insurmountable patient debt.  Phil’s wife began to panic about their future and her debt inheritance. In spite of loving her husband, divorce has felt like the only solution to avoiding financial devastation. 

Sadly, as healthcare costs rise, more Americans find themselves in similar situations. The United States spends more on healthcare than any other nation, without better results. Uncontrolled costs waste money and may be worsening the health of cancer patients. An astounding 30 percent of advanced cancer patients reported financial distress higher than physical or emotional distress. In these cases, the cost of care was literally more toxic than the effects of cancer or cancer treatment. 

Yet, oncology care can be delivered for far less money. The American Society of Clinical Oncology found that the costs of treating metastatic colon cancer in Washington State vs. British Columbia was double in the US compared to Canada, with similar outcomes. American doctors provide some of the highest quality medicine in the world, but the associated costs are neither affordable nor sustainable.

Much of this financial toxicity could be eliminated with a single payer system. Such a system would reduce the administrative costs associated with the ‘business of medicine’ — costs accounting for 25 percent of American healthcare charges.  Additionally, small companies would not be responsible for expensive healthcare benefits, and citizens could endure job change more safely.  A single payer system would also allow medical providers to get paid appropriately for services, but industry CEOs could no longer inflate costs in a market that profits from the sickest and most vulnerable Americans. 

Healthcare as a private enterprise is hurting people like Phil and his wife. It is increasing the suffering of cancer patients. The Canadians have proven that the same care can be delivered at half the cost. It’s time to put politics aside and move forward with a similarly designed system, with the goal of improving the health of Americans without the toxic burden of medical debt.

Dr. Leila Ali-Akbarian is a Public Voices Fellow and a primary care physician who practices Cancer Survivorship and Palliative Care at the Banner-University of Arizona Cancer Center.

7 replies »

  1. I would never want to belittle anyone’s financial distress…..but in the divorce case that is cited here, I do ask if the health insurance has an out of pocket limit. I think that virtually all policies have that now.

    Maybe the drugs involved are not covered at all by the insurer. That is very wrong.

    Does the drug manufacturer have charity and rebate discounts?

    Also is bankruptcy an option for the couple.

    Thanks for any details you wish to share….

  2. Fantastic column, but – though it doesn’t touch your main point – Brokaw said his drug costs were $10,000 or so a WEEK, not per day, so you might want to correct this minor point.

    The stress our crazy, complicated, expensive system puts on sick people is horrible.

  3. Sorry, but in oncology, as in all procedural fields, the dream of Single Payer will get us MORE procedures and treatments. We are overtreated by about 30% (Berwick, Brownlee, Pearl, Gawande). It’s been very well documented that overtreatment results in paradoxically *worse* outcomes. The only way to change this is to change the financial incentive to one which encourages optimum care, not, as Single Payer does, more care. The only way I know to do that is pre-payment (Pearl).

  4. “It has to be the province, doesn’t it?”

    OK, but I don’t see government direct pay as “third party” – maybe 2nd party after patient. Any way much better system which is more efficient and cost controlling as is demonstrated by most of the rest of the world.

    Provinces have had surgery wait listing problems but have worked to correct this in recent years, although no one waits for ER surgery. It forces Canadians to confront increase in taxes versus better access compromises.

    Americans don’t want to compromise on anything, “give me all the health care I want to use but lower those prices.”

  5. It has to be the province, doesn’t it? The provider directly sends his claim to the province. I’m not against insurance if it paid the patient directly, who, in turn, pays the provider—as in indemnity insurance. I think it is vital that everyone feels that the patient is paying the provider. …including Pharma. Vouchers are the only way to do this because it allows us to subsidize the poor, etc.

  6. “Canada is also a third party payer system”

    Who is the “third party payer” in Canada?

  7. It is astonishing how costly our system has become. I believe the root defect is third party payers. Canada is also a third party payer system but its politicians had the courage to at least install monopsony purchasing and price controls which can bring prices down…although everyone fudges. But, take any sector of the economy, and have insurers pay for everything, and I think one can predict that prices will zoom….especially if there is no group purchasing or price controls.

    I don’t have a clue as to how we are ever going to get the political will to change our system—what with all the millions of stakeholders who love making a good income.

    Personally, I would like to try a refundable/convertible voucher system—using Medi-bucks to buy health services.
    —but this is conceptually hard to explain and all the stakeholders would howl. It would be hard to bring Pharma in.

    Two principles stand outlined:

    1. The providers have to believe they are dealing with the patient directly. All kinds of good things will happen from this.
    2. We have to be able to subsidize the poor, the really sick, the aged, etc., and we have to do this with vouchers that we give them and which are thought of as money by the providers and patients and can be redeemable as money if they are not used by the patient or turned into cash by the provider upon redemption.

    We can’t use plain old money. We have to use vouchers. Money would leak out of the system and be used by everyone for other things.