Can Financial Toxicity Impact a Patient’s Mental Health?
The high cost of health care is a burden for millions of Americans. Health care costs have grown faster than inflation, making it difficult for many – even those with insurance – to afford medical care and drugs.
Consider these concerning statistics:
- Nearly half of U.S. adults struggle to cover the cost of prescription drugs and doctor visits. (West Health-Gallup Healthcare Affordability Index)
- 1 in 4 adults has skipped or postponed getting health care they needed because of the cost. (KFF)
- 23% of adults who have health coverage are underinsured. (Commonwealth Fund)
- 3 in 10 people with chronic health problems do not fill a prescription for their condition because of the cost. (Commonwealth Fund)
Researchers coined the term “financial toxicity” to describe the financial burdens, health effects, quality of life impacts, and emotional distress patients and their families experience related to high out-of-pocket costs associated with diagnosing and treating a chronic or life-altering disease like cancer.
Several recent studies, led by Jeffrey M. Peppercorn, MD, MPH, and Suzanne Miller, PhD, have shed light on the problem of financial toxicity and how one solution – the use of Charitable Copayment Assistance Programs (CPAPs) – is helping patients stay on their prescribed treatments and alleviate the mental stress associated with high cost burdens.
Dr. Peppercorn is an oncologist at Massachusetts General Hospital and Associate Professor of Medicine at Harvard Medical School. Dr. Miller is Professor of Cancer Prevention and Control and Director of the Patient Empowerment and Decision-Making Department at Fox Chase Cancer Center/Temple University Health System.
Cost Discussions Among Recipients of Copay Assistance
In a 2022 study published in The Oncologist, Dr. Peppercorn, Dr. Miller, and their colleagues conducted a national survey of CPAP recipients with cancer or autoimmune conditions to assess patient perspectives on discussions of costs of treatment with their providers. Most (62%) reported a desire to discuss costs, but under one-third reported that such discussions occurred.
Additionally, 52% of respondents wanted their doctor to consider out-of-pocket costs when selecting a treatment, and 61% felt that doctors should ensure patients can afford the treatments prescribed. Patients suffering from depression were more likely to want doctors to consider out-of-pocket costs and to believe doctors should ensure patients can afford treatment.
“The [study’s] findings underscore the importance of addressing financial toxicity as financial toxicity may compound the psychosocial aspects of cancer and other diseases,” concluded the authors. “It highlights the need for interventions to attend to the psychosocial/depressive symptoms of patients and ensure that interventions to address costs are targeted appropriate[ly].”
Screening for Financial Toxicity
One of the goals of the study published in The Oncologist was to give clinicians insight into the degree of concern about costs of care among patients and to evaluate their preferences for how this is addressed. It highlighted the need for universal screening and discussions around financial burden.
Dr. Peppercorn further examined the concept of screening for financial toxicity in a review article published in JCO Oncology Practice. Here, he and his colleagues provided examples of various tools that can be used to screen for financial toxicity in clinical oncology practice.
He and his co-authors noted that “within routine clinical practice, in which clinicians seek to evaluate many important issues, a lengthy survey for each potential problem is not practical.” The article identifies several shorter screening tools that can be used to efficiently assess financial toxicity.
The authors note that despite a range of validated financial toxicity screening tools available and the recognized need for screening in clinical practice, there is currently no standard approach. Moreover, the prevalence and content of screening are highly variable among U.S. cancer centers.
In addition to acknowledging the “clear interest in developing a brief screening tool that can be used in routine practice,” the authors advised clinicians to “remember that screening does not eliminate the need for clinical vigilance regarding potential financial toxicity.” Doctors need to be open to conversations about cost and should make sure patients are getting the care they need without major financial burdens, on top of any routine screening efforts. Once identified, “financial toxicity should be addressed, patients referred for financial counseling and assistance, and efforts made to develop a care plan that can minimize financial toxicity while ensuring access to high-quality care.”
Charitable Copay Assistance is a Critical Safety Net
The largest survey yet examining seriously ill patients receiving charitable copayment assistance found high out-of-pocket costs impact access to health care, adherence to medication, and quality of life, even for those on Medicare.
Published in Cancer, the survey focused on patients with cancer or serious autoimmune diseases such as multiple sclerosis. It showed deep financial distress, with many Medicare patients saying they had delayed important aspects of care because of the costs or were paying nearly 10 percent of their income on health costs.
In the study, 31 percent of respondents reported moderate or severe financial distress and said they would be forced to go without treatment if they lost their charitable copay support. Ninety percent of charitable copay grant recipients worried about what would happen if they lost copay assistance.
According to Dr. Miller, a co-author of the study with Dr. Peppercorn, little has been known about the role charitable copay assistance plays in access to care and financial distress.
Suzanne Miller
“The experience of patients needs to be part of the public discussion about charitable copay assistance,” said Dr. Miller. “This research adds considerably to the still sparse literature describing recipients of charitable copay assistance grants and shows the important role this assistance plays for patients in the American health care system.”
HealthWell’s Chairman of the Board, David Knowlton, former President and CEO of the New Jersey Health Care Quality Institute, commented in Oncolytics Today on the survey and the emotional impacts of being unable to afford needed care: “Imagine you or someone you love being diagnosed with a life-threatening disease such as cancer. You are overwhelmed and scared. Then you feel such relief when you learn there’s a breakthrough medication that can make an enormous difference, maybe even be lifesaving. But then your hopes are dashed when you learn the copayment – sometimes thousands of dollars each month – puts your medicine out of reach.”
When Health Insurance Isn’t Enough
Patients facing the burden and anxiety of high treatment costs can turn to CPAPs like HealthWell Foundation for assistance. HealthWell has awarded more than $4.8 billion in financial support for cancer and other serious illnesses, including multiple sclerosis, amyotrophic lateral sclerosis, and cystic fibrosis, since its founding in 2003. In addition to providing support for medications, HealthWell has a fund to help cancer patients with the costs of home care services and durable medical equipment, and one to support behavioral health services for oncology caregivers.
Jeffrey M. Peppercorn
“CPAPs like HealthWell play an important role in promoting access to care in today’s health care landscape,” Dr. Peppercorn said. “Not only do they provide financial support that helps patients to start and maintain their treatment, but addressing financial burdens can help reduce stress for patients and their families. A complex illness like cancer brings enough emotional distress and questions about whether patients will be able afford the best treatment or what the costs of care will do to their family should not be part of the equation.”
