ASCO Connection

July 2017

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By S. Yousuf Zafar, MD, MHS, Lee N. Newcomer, MD, MHA, Justin McCarthy, JD, Shelley Fuld Nasso, and Leonard B. Saltz, MD Cancer is one of the most expensive diseases to treat in the United States. The median price of a month of che- motherapy has increased by an order of magnitude during the past 20 years, far exceeding inflation over the same period. Some would maintain that pre- scribing patterns further contribute to higher costs. In the most common models of cancer care delivery, oncolo- gists have little incentive to contain treatment costs when they prescribe chemotherapy, and only recently have considerations of cost and affordability begun to be openly incorporated into guideline development. Because of increasing deductibles, increasing premiums, cost sharing, coinsurance, and frequent copayments, patients are directly shouldering a greater portion of those costs. 1 One in three American families face health care bills they cannot afford, and 50% of elderly Americans with can- cer pay at least 10% of their income toward out-of-pocket treatment-related expenses. 2,3 A growing body of lit- erature has described the treatment- related financial strain experienced by patients with cancer, often called the financial toxicity of cancer treatment. These studies have described how an increasing portion of patients with cancer are at risk for cutting back on groceries, selling their homes, being nonadherent to their prescribed treat- ment, or —in the most extreme cases— declaring personal bankruptcy to pay for their cancer treatments. 4,5 What can we do to intervene on treatment-related financial toxicity of patients? Without question, any mean- ingful steps toward lower costs will involve collaboration among the phar- maceutical industry, insurance providers The views and opinions expressed in Current Controversies in Oncology are those of the authors alone. They do not necessarily reflect the views or positions of the Editor or of the American Society of Clinical Oncology. This issue's "Current Controversies in Oncology" is excerpted from the 2017 ASCO Educational Book, an NLM-indexed collection of articles written by ASCO Annual Meeting faculty and invited leaders from ASCO's meetings. Published annually, each volume of the ASCO Educational Book highlights the most compelling research and developments across the multidisciplinary fields of oncology. Read the complete article and more at asco.org/edbook. EXCERPT FROM How Should We Intervene on the Financial Toxicity of Cancer Care? FEATURES l Current Controversies in Oncology 22 I 07.2017

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