The direct “financial toxicity” of cancer diagnosis and treatment


An interesting new paper in Cancer has offered us a sophisticated assessment of the effects of a diagnosis of and treatment for cancer on employment and income of all adults (aged 18 and older) and of adults in their  prime working years (aged from 25 and 64).

While the term “financial toxicity” has commonly been applied to the problems of addressing the costs of cancer care, another form of “financial toxicity” is evident in the loss of family or individual income because of the inability to work regularly or the actual loss of employment associated with a diagnosis of cancer.

In this new paper by Zajacova et al., the authors have used socioeconomic data from the ongoing Panel Study on Income Dynamics (PSID) to explore the impact of a cancer diagnosis on “key dimensions of economic well-being among US adults”. The PSID study has been ongoing since 1968, i.e., for most of the past 50 years. The current study was primarily based on data from study participants collected between 1999 and 2009 — the 10 years during which information about cancer diagnosis and its treatment was collected.

The study does not break down socioeconomic data by cancer type, so we have no idea how many of the patients diagnosed with cancer were actually diagnosed with prostate cancer.

The research team was focused on four, carefully selected outcomes, which were the impact of a cancer diagnosis and treatment on

  • Employment
  • Hours worked
  • Individual income
  • Total family/household income

Here are some of the key characteristics of the data sample from the eligible participants in the study:

econ

And here are the core study findings:

  • The total eligible study sample included 1,117 individuals who had been diagnosed with cancer and 15,856 individuals who had no cancer diagnosis within the study period.
  • Significant effects of cancer diagnosis/treatment were noted on all four outcomes.
  • The probability of employment of cancer patients dropped by up to 9 percent in year 3 after diagnosis, with evidence of recovery in  years 4 and 5.
  • The number of hours worked dropped by up to 200 hours in the year following diagnosis, and then seemed to start to recover.
  • The annual labor market earnings of cancer survivors dropped by  near to 40 percent within 2 years of diagnosis and remained low through years 4 and 5.
  • Total family/household income dropped by > 20 percent in years 2 and 3 post-diagnosis, but recovered in years 4 and 5.
  • These direct economic impacts on cancer survivors were primarily driven by the effects of a diagnosis of and treatment of cancer in males as opposed to females.
    • Among men aged between 25 and 64
      • The probability of being employed dropped by nearly 20 percent
      • The number of hours worked dropped by > 300 hours per year
      • Their annual labor market earnings decreased by 60 percent in years 3 through 5 post-diagnosis.
      • Total family/household income dropped by > 40 percent
    • Among women aged between 25 and 64, the economic impacts were (by comparison) largely statistically insignificant.
    • Effects among all adults aged 18 and over were similar to but somewhat smaller than  those among adults aged 25 to 64 (and the effects were again more pronounced among men as opposed to women).

The authors are careful to note that the differences between the economic impact of a cancer diagnosis on a family/household are potentially largely a consequence of the higher overall labor-market participation of men compared to women. However, it may also be the case some men’s jobs are very physically demanding, making working during treatment almost impossible under many circumstances.

It is clear from this study that the “financial toxicity” of cancer is by no means limited to dealing with the costs of care and treatment. Indeed, those costs come on top of the “financial toxicity” directly caused by the diagnosis and the need for treatment — a factor largely ignored in other recent discussions about costs and value of cancer treatment.

 

2 Responses

  1. On the associated topic of drug “value” here in the USA, even Reuters has now decided to take a position.

    Based on a panel discussion coordinated by Reuters, late on Friday last week they reported that “U.S. drug prices should reflect value to patients“. However, it still appears to be unclear how we might be able to accomplish such a feat.

  2. An Idea to Help Rein in Excessive Drug Prices (Similar to Secondary Boycott)

    The foundation of this idea is patient empowerment. The key aspect is being able to get a rough idea of reasonable pricing for a drug so that substantially excessive pricing can be identified followed by economic punishment of the irresponsible company. As someone with a career involving a lot of cost analysis and some market analysis, I believe this will be possible, though somewhat complex and challenging, in many cases. Some cases will be slam dunks!

    Here is the core tactic: a widely coordinated boycott by patients of other products of a company, for which there are reasonable alternatives, who sell certain drugs at a substantially excessive cost. Frequently, those excessively high priced drugs are the only choice available, so it is not feasible for patients to boycott such drugs, though boycott is certainly a good tactic when there are satisfactory alternatives. In other words, if Drug Squeezeum is excessively priced but there is no alternative, but the company also sells Drug Runofthemill with a fairly large market share, patients would boycott Drug Runofthemill.

    This strategy would probably require some high level coordination by patient advocacy groups, and those calling for a boycott would need to use self-discipline in order to responsibly determine which drugs to target, to determine when demands are met, and to determine when to end the boycott, as well as identifying the company’s drugs that can be boycotted without harming patients.

    Reasonable pricing for drugs should try to allow for such very important factors as:

    — Profit for investors (especially in highly risky ventures), including the size of the market for the drug;
    — Research and development costs (including amortization of costs for unsuccessful attempts at drug development, as well as funding for future drug development/expansion of medical indications/reductions of side effects, but minus investment by the government and non-profit entities);
    — Marketing and operating costs to provide the drug;
    — The number of years for sales prior to loss of patent protection;
    — The number of years before competitive products are likely to emerge and reduce the drug’s market share (really tricky here); and
    — Some allowance for late benefits of the drug that add to the initial market and may occur after expiration of patent protection (e.g., the drug metformin, a diabetes drug, that has shown exciting potential in cancer treatment) (really tricky here);
    — Other factors (I’m fairly experienced here but not a business expert).

    Many of us have benefited enormously from drug developments backed by investors willing to take large risks, and I, for one, want to see them well rewarded. On the other hand, many of us have been pushed around by some large drug companies and have had our hard-earned dollars siphoned from our pockets into theirs. (Mr. Martin Shkreli comes right to mind.) Wouldn’t it be nice to turn the tables on the miscreants?

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