It’s a figure that might be shocking: 50% of people diagnosed with cancer would rather avoid costly treatment that might save or prolong their life in favor of avoiding bankruptcy.
Upon learning this, Anurag Singh, MD, Director of Radiation Research and Director of Head & Neck and Lymphoma Radiation Services at Roswell Park Comprehensive Cancer Center, realized he’d been missing out on a key component of talking with his patients.
“What that showed me is I was thinking about things completely wrong. What’s important to the patient might not have been what I had assumed was important to the patient,” he says.
As a researcher who studies not only radiation but financial toxicity — a term that “encompasses all the toxicities patients experience as a result of financial stress or pressures” associated with cancer treatment, he explains — Dr. Singh incorporated a new question when meeting with his patients after they’ve been diagnosed.
“We’ve asked people a single question: How concerned are you about your finances? It’s multiple choice and the options are: none, a little, somewhat and very. The first two categories, we consider that normal. The last two, we consider that you have financial stress. We’re not getting into the weeds of why you’re having stress, we’re just asking, on a patient level, how are you feeling, how are you coping,” he says.
An unexpected factor in cancer care
Dr. Singh’s concerns about financial toxicity aren’t just based on worries about his patients’ bank accounts. “What we found is a huge decrease in overall survival in the patients who are concerned about their finances,” he says. Research indicates that “people who had been experiencing financial toxicity may have had worse outcomes.”
There isn’t an exact reason that has determined why increased financial stress can negatively impact someone’s cancer treatment, but Dr. Singh says it could have something to do with stress levels becoming chronic in the patient’s body. At that point, “it becomes counterproductive to what you’re trying to accomplish — being prepared to accept cancer therapy and have your own systems be optimized to fight the cancer.”
To help mitigate these factors, Roswell Park has started offering financial counseling services to patients who express concern about their ability to pay for treatment.
Tameka Brooks, a Community Outreach and Engagement manager who specializes in financial literacy, begins by asking patients whether they rent or own their home. “We want to make sure you continue to have shelter,” she says. There are programs to help cover the cost of other expenses — utilities, car payments, etc. — but housing is a primary concern.
Brooks will help reach out to the patient’s landlord or mortgage company in an effort to make arrangements to keep the patient in their home. “A letter from your doctor is more meaningful than anything. It’s proof you’re going through this. Overall, it can help you.”
Ideally, she’d like to see more conversations about money, savings, insurance and end-of-life preparation start in each family home, even when children are young. “Everyone needs financial education. I think it needs to start in kindergarten,” she says. “We need to sit down and prepare for this.”
Financial conversations can be life saving
Dr. Singh isn’t advocating that all doctors talk with their patients about their finances; most doctors aren’t trained or equipped for that. “The reality is that patients have been asked and fewer than 10% want to have this discussion with their doctor. I’m not qualified to have an opinion about why that may be the case.”
But if patients start to express concern about their finances, it’s important to stress that delaying or stopping treatment could be costly in another way. Dr. Singh says he reminds patients that head and neck cancers, “if left untreated, can become very symptomatic. No one wants to experience that if they can at all avoid it regardless of what the financial implications are. Now that we have Tameka and we have the financial navigation (program), it’s a much easier process to say I’m going to help you address these concerns through resources available at Roswell Park, including financial counseling and financial aid and everything else we do here.
