9American Cancer Society Cancer Action Network The Costs of Cancer 2020
Cancer Institute—as well as for academic and
industry researchers. Decades of significant
investment is resulting in a steady stream of new
treatments becoming available to cancer patients
and their providers. Many of these new treatments
are pharmacological. Some innovations—like
chimeric antigen receptor therapy (CAR-T), which
takes a patient’s own immune system cells and
changes them in a laboratory to attack cancer
cells before re-infusing them
6
—belong in their
own unique category. Some new personalized
therapies require biomarker testing (sometimes
called “genomic testing”) to determine if the
patient has the particular type of cancer the
personalized therapy treats.
Because of the way industry recoups costs for
research and development, a newer treatment
is likely to be more expensive than when it has
been used for many years and competitors
have developed generic or biosimilar versions
of the drug. This often results in higher out-of-
pocket costs for a patient using a new treatment,
especially if they must pay co-insurance, cannot
use copay assistance, or are uninsured. Also, if a
treatment is very new, a patient’s insurance plan
may not have added it as a covered benefit yet or
may consider it ‘experimental.’ In these situations,
a patient may be able to appeal to their insurance
plan for coverage of the treatment–otherwise
their out-of-pocket costs will likely be very high
for an uncovered treatment or a patient may opt
to go without the treatment.
Other Types of Cancer Care Costs: While
surgery, radiation and pharmacological therapy
are the three most common approaches to cancer
treatment, patients may utilize other regimens like
stem cell transplants, hyperthermia, photodynamic
therapy and blood transfusions. Cancer patients
also often need treatments such as supportive or
palliative care, rehabilitative therapy, mental health
services, nutrition counseling and cardiology
consultations as a result of their cancer or
treatments.
7
It is also important to note that these various
forms of treatment require multiple types of health
care personnel. It is very common for people
with cancer to see multiple health care providers
during the course of their treatment, including
primary care doctors, specialists for diseases and
side effects developed as a byproduct of cancer
treatment (like cardiologists, neurologists and
endocrinologists), medical oncologists, radiation
oncologists, surgeons, palliative care specialists,
rehabilitation specialists, physical therapists and
nutritionists. The complexity of cancer treatment
and the necessity of multiple specialists are
large drivers of cancer patient costs. Many health
insurance plans charge higher co-pays or co-
insurance amounts for specialist visits compared
to primary care. Additionally, very specialized
providers are often in short supply, and patients
are sometimes forced to go out-of-network to see
a specialist. This is especially likely for patients
who live in more rural areas.
Rural residents are more likely than their
urban counterparts to have higher rates of
unemployment and lack of health insurance.
10
Survivorship Care Costs: It is also important
to note that even when a person with cancer
has completed their surgery, radiation and/
or chemotherapy, the costs of care do not end
immediately. Many cancer survivors deal with
cancer symptoms and side effects of treatment
months to years after finishing treatment—
sometimes for the rest of their lives. Some cancer
survivors also must take treatments long-term, like
a 10-year regimen of hormone therapy to prevent
breast cancer recurrence. This means many of
the costs discussed in this section, including
for seeing specialist providers like rehabilitation
therapists and psychotherapists, can continue
for years for cancer survivors. In fact, research
shows that annual health care expenditures for
cancer survivors are significantly higher than for
individuals who have never had cancer.
11
Indirect
costs of cancer—explored on the next page—also
often continue into survivorship.
Survivor Views: The Costs of Cancer in
Their Own Words
“One of the most surprising things is the cost
of care AFTER active cancer treatment. I have
lymphedema and the costs are significant,
including various equipment, DME [durable
medical equipment], compression clothing,
and physical therapy. I didn’t realize the costs
would continue after active treatment.”
Breast Cancer Survivor, Arizona
The Costs of
Cancer Disparities
■
Urban areas have
approximately 5
times the number
of oncologists
compared to rural
areas.
8
■
Rural patients have
to travel nearly
twice as long one-
way as urban and
suburban patients
in order to see their
cancer doctor.
9