Cancer care is expensive, but pharmacists can help.
Cancer care is associated with significant financial toxicities, both in terms of out-of-pocket costs to patients and caregivers and in terms of health care burden in general.1 Drug Topics® interviewed several experts to discuss the role of pharmacists in reducing the cost of cancer care.
The cost of cancer care
According to Daniel Zlott, PharmD, senior vice president at the American Pharmacists Association (APhA), multiple aspects of cancer care can place different financial burdens on patients and their families. “Depending on the type of cancer a patient is being treated for,” he said, “it is not uncommon for patients to require frequent visits with their oncologist, undergo one or more surgical procedures, and a series of chemotherapy infusions or radiation treatments.”
In addition, Zlott noted that caregivers of patients with cancer also face potential financial burdens associated with their care responsibilities. “Cancer treatment can be just as demanding for health care providers who may also need to take time off from work to support their family member(s) during their treatment,” he said.
For patients who are still employed, Zlott added, managing their cancer can quickly deplete leave and sick leave balances and, consequently, lead to loss of wages. “Also, the cancer treatments themselves can make people feel unable to work or, depending on their work responsibilities and the type of treatment the patient is receiving, make it unsafe for them to work,” he added.
Lisa Holle, PharmD, clinical professor in the School of Pharmacy at the University of Connecticut, and a member of the Drug Topics® Editorial Advisory Board, echoed these statements, stating that the greatest financial toxicity facing cancer patients is the cost of cancer drugs. “Even if they have prescription drug insurance, co-payments or deductibles can incur significant costs,” explains Holle.
According to Holle, the average out-of-pocket cost for nearly all orally administered cancer drugs is about $10,000 per month. “Most of our newer therapies given intravenously cost thousands of dollars per treatment,” she said. Chimeric antigen receptor T-cell therapy is one of the more expensive therapies, Holle added, although the “total cost of long-term cancer care could be lower if no further treatment is needed.”
Alexandre Chan, PharmD, of the School of Pharmacy and Pharmaceutical Sciences at the University of California, Irvine, said in a telephone interview with Drug Topics® that many of the diagnostics used in cancer care also involve significant costs. “Some insurance plans may not even pay for some of those activities,” he explained.
In addition, Chan noted that managing certain symptoms, such as neuropathy, can also contribute significantly to the financial impact of cancer care. “We don’t really have a lot of good drugs for managing many of the symptoms that patients experience,” he added. Some integrative and complementary approaches to symptom management, such as acupuncture, may not be covered by insurance plans, as the evidence for these approaches is not as strong as the data available for controlled medications.
How Financial Toxicities Affect Cancer Patients
The financial impact of cancer treatment can be very diverse and depends on the circumstances of the individual patient, explains Zlott. “At one end of the spectrum is a person with excellent insurance and a workplace with policies that are very supportive of people with serious illness,” he said. “At the other end of the spectrum are individuals without insurance and out of work, or who work for an employer who is unable or unwilling to support its employees going through a serious illness.”
Direct financial consequences of cancer treatment range from lifestyle changes, such as reducing spending on recreational activities and vacations, to more serious problems such as the inability to pay day-to-day bills because of the cost of cancer care, Zlott added.
Patients who wait to see if they can afford their treatment and/or meet qualifications for company-sponsored or foundation assistance may also experience delays and interruptions in care, potentially compromising clinical outcomes. added Holle. And if a patient does qualify for financial aid: “There is often a period within each year when they have to reapply, [where] funds in the program may temporarily run out, or [where] they must meet some criteria for insurance, which can interrupt care,” Holle said. “Financial toxicity of a regimen can prevent a patient from getting that regimen if they can’t afford it.” [it] and there is no financial aid available so you may need it [the] patient to have another treatment option.”
In addition, the high costs associated with cancer treatments can lead to mental/emotional health disorders, adding to the overall burden of the disease and its management.2 “It’s also important to consider the mental stress or strain that these types of financial situations place on people with cancer and their families,” Zlott added. “This strain can lead to mental health conditions, such as anxiety and depression, which also need to be screened for and addressed by the patient’s healthcare team.”
What pharmacists can do?
The most important thing a pharmacist can do to help reduce the cost of cancer care is to help patients identify the cheapest options available. However, he pointed out that in “many cases there are not many choices available due to a lack of available generic drugs or less expensive treatment options.”
In these cases, pharmacists can work with patients to find prescription aid programs, refer them to charities that help patients with cancer, and refer them to “other members of the health care team, such as social workers, who can further assist patients in addressing problems.” the financial burden associated with cancer care.”
Holle added that pharmacy technicians can also work with pharmacists to assess patients’ financial needs and determine the availability of and suitability for financial assistance programs for care or drug replacement. Pharmacists may also try to minimize time in the infusion room for treatment so that patients can resume their normal routine, which can help reduce the time they spend outside of work. She also suggested that pharmacists could try to become more involved in developing formulation recommendations for pharmacy and therapies and/or clinical pathways that better reflect treatment-related financial burdens.
Using biosimilars alongside generic drugs may also help lower the overall cost of cancer care, Zlott noted. “Requesting pre-approval from a patient’s insurance company can also have a major impact on a patient’s out-of-pocket health care costs if the pre-approval is approved,” he added. “While these interventions certainly help, they are not enough to help reduce the overall cost of cancer care for many patients.”
Many oncology pharmacists can give chemotherapy for the first time and, instead of just focusing on the cost of drugs, they can focus on the best way to manage disease and treatment-related symptoms in a cost-effective way, Chan added. “Focusing on if patients even tell you that they have financial problems or that they have other problems that they need help with is [also] important. At least we’re able to address them as a bigger picture, rather than just focusing on very rudimentary side effects.”
The multidisciplinary care team acts as a coordinated, collaborative source of care to ensure that all patient needs are met, including concerns about the cost of and access to treatment. “Pharmacists work with the healthcare team to identify and address side effects associated with cancer care as quickly as possible to ensure patients have the best possible quality of life while undergoing cancer treatment,” explains Zlott.
Since drugs can contribute significantly to the overall cost of cancer care, pharmacists are “well positioned to identify options that may be available to help a person with cancer”, while communicating all relevant financial concerns to other members of the care team. ‘ said Zlott.
“When a pharmacist is involved in a multidisciplinary team and they work together to deliver care, they can provide guidance and recommendations that are cost-effective and reduce the financial burden on the patient,” said Holle. “By conducting medication reconciliation, they can identify potential medication-related issues and provide solutions in the belief that they avoid additional healthcare issues and thus costs.”
Pharmacists, she added, along with other clinicians, can ensure that financial offerings and social workers are involved to help alleviate the financial burden beyond the cost of drugs.
Improving communication can also be crucial, Zlott said. “I think the most important point for people with cancer is to be open with their healthcare team about the financial impact their cancer care is having on them,” he said. “There are many tools and resources available to the healthcare team to help patients who are experiencing financial challenges, but the healthcare team cannot help if they don’t know the patient is experiencing financial difficulties.”
1. Iragorri N, de Oliveira C, Fitzgerald N, Essue B. The out-of-pocket cost burden of cancer care – a systematic literature review. Curr Oncol. 2021;28(2):1216-1248. doi: 10.3390/curroncol28020117
2. Essue BM, Iragorri N, Fitzgerald N, de Oliveira C. The psychosocial cost burden of cancer: a systematic literature review. Psycho-oncology. 2020;29(11):1746-1760. doi:10.1002/pon.5516