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The rising costs of anti-cancer treatment in the United States have placed adolescents and young adults with cancer at an increased risk for financial toxicity.
A 2011 study from the National Institutes of Health (NIH) projected that healthcare spending on cancer care in the United States would hit at least $158 billion by 2020. However, an estimated $161.2 billion was spent on cancer care by 2017. Exorbitant figures have become common place in oncology discourse as the price of care continues to rise. In the U.S., spending on anti-cancer medications reached $71 billion in 2020, with approximately one-third of Medicare’s expenditure on anti-cancer treatment being devoted to medication costs. On the global market, reports estimate that anti-cancer medications will increase from $164 billion in 2020 to an estimated $269 billion by 2025.
According to the Centers for Disease and Control Prevention (CDC), the total cost of cancer care in the U.S. will exceed $240 billion by 2030. Should the trend from 2011 repeat itself, that number could be significantly higher come 2030. Growing costs have placed patients with cancer at an increased risk of financial toxicity, as they are 2.5 times more likely to declare bankruptcy because of their diagnosis. These financial difficulties continue after treatment, as survivors of cancer generally report higher out-of-pocket costs than those without a cancer history. For patients with cancer, survival comes with an economic cost—for adolescents and young adults (AYAs), that cost is felt throughout their lifetime.
In the U.S., around 90,000 AYAs (those age 15 years to 39 years) receive a cancer diagnosis each year, representing about five percent of all new cancer cases. In 2019, the 5-year relative survival rate of AYA patients with cancer was 85 percent. As advances in treatment and awareness of the importance of cancer screening increases, that number could grow even higher. However, AYAs have historically been among the highest uninsured/underinsured age groups in the U.S., placing them at an increased risk of financial toxicity.
The lack of adequate healthcare coverage among AYAs is primarily due to their inability to access employment-based insurance, which is the most common type of health insurance in the U.S.—covering 54.4 percent of the total population in 2020. In addition, an evolving professional landscape, fueled by the rise of the gig economy (a labor market that relies heavily on temporary and part-time positions filled by independent contractors and freelancers, rather than full-time, permanent employees), means that AYAs are more likely to work in positions without comprehensive benefits, such as health insurance.
Recognizing the challenges AYAs face as they navigate the cancer care continuum, Teen Cancer America engaged the services of Deloitte Access Economics for a study designed to estimate the total costs incurred by AYA patients with cancer over the course of their lifetime. This study was commissioned in 2021, and its report was recently published in the Journal of Clinical Oncology. Findings from the study place the economic and human costs of cancer among AYAs diagnosed in 2019 at $23.5 billion overall—a lifetime cost of nearly $260,000 per person. The majority of these costs are accumulated by AYA survivors of cancer in the form of lost productivity due to illness, decreased well-being, and loss of life.
According to researchers, a cancer diagnosis at a such a formative stage in life can drastically impact the overall life trajectory and financial status of teenagers and young adults. This often leads to missed opportunities for education and income, as well as the need for ongoing mental health and survivorship care support. “The bottom line is that it’s worse than anyone thought, and it doesn’t end for AYAs at the end of treatment,” said Susan Parsons, MD, MRP, lead author of the study. “The more sobering aspect of the report is the continued financial peril for these patients and their families long after cancer is treated."
Findings from the study discussed above indicate that healthcare costs can be significantly reduced, potentially resulting in drastically improved patient outcomes, if investment in research, treatment, prevention, and expanded patient-facing resources is increased.
Further, the Association of Cancer Care Centers (ACCC) is helping the multidisciplinary cancer care team meet the financial needs of oncology patients through the work and dedication of its Financial Advocacy Network. So this year, the network published and launched its updated Financial Advocacy Service Guidelines at the 49th ACCC Annual Meeting & Cancer Center Business Summit. These guidelines aim to help cancer programs and practices everywhere implement the financial advocacy services deemed necessary to best assist patients and their families in accessing necessary resources throughout their cancer journey. For more information on the Financial Advocacy Services Guidelines, including the downloadable resource with implementation considerations, visit the ACCC website.
The ACCC Financial Advocacy Network is supported by Bristol Myers Squibb, Pfizer, Daiichi-Sankyo, Janssen, and Pharmacyclics. The network is also supported by key partnerships with CancerCare, the Academy of Oncology Nurse & Patient Navigators, and National Patient Advocate Foundation.