Op-ed: The financial toxicity of cancer is growing. Here’s what can be done to reduce it

Cancer drains individuals of their physical, emotional, and financial health. Given the impact on both patients and the people in their lives — including their employer — it’s time that CEOs take note and take action to reduce the burden of cancer.

In a study from the American Cancer Society Cancer Action Network, nearly half of cancer patients and survivors reported being extraordinarily burdened by medical debt. Many respondents carried a negative balance of at least $5,000 from their cancer treatment for more than one year, and 42% of people with cancer deplete their life savings within the first two years after diagnosis.

Financial hardship caused by cancer can also contribute to “financial toxicity,” wherein the cost of treatment forces individuals to make tradeoffs that impact their chances of survival. These may include non-biologic factors such as skipping or halving cancer medications to stretch their supply, or being unable to complete cancer care as planned due to the high costs of transportation to or housing near cancer treatment centers. This model isn’t sustainable, and rising costs of new, life-saving cancer therapies will impose additional financial toxicities — and an increasingly large threat to patients’ lives.

Not only does financial toxicity of cancer care affect the individual, it can also negatively impact their employer. As the providers of health insurance coverage for nearly half the country, employers and unions shoulder much of cancer’s financial burden. Today, cancer is the leading health-care cost for mid- and large-sized organizations in the U.S., and the burden is growing.

For the first time in history, more than 2 million Americans will receive a new cancer diagnosis in 2024. While increasing cancer incidence can be attributed in part to our aging population (cancer risk increases with age), we also see a disturbing national trend in which younger people are being diagnosed with 17 major cancers. These are people who would still likely be in the workforce, using employer-sponsored health insurance. As a result, employers are asking what they can do to reduce the burden of cancer on their populations — and their bottom line.

Patients, families, and employers all “win” when cancers are diagnosed at an early stage. Detecting cancer early not only improves chances of survival, it significantly lowers the cost of care. Overall, treatment costs for someone diagnosed at stage IV — when cancer has spread throughout the body — are an average of $156,000 higher than for those diagnosed at stage I, when the disease is localized. The first year of treatment for colorectal cancer, which affects over 150,000 individuals each year in the United States and is on the rise in younger populations, costs an average of $111,000 when diagnosed at stage I, with about a 90% five-year survival rate. By contrast, stage IV colorectal cancer drives average treatment costs of $256,000 in the first year, and five-year survival rates are under 20%. Evidence suggests that if individuals could only take advantage of the prevention, early detection, and cancer treatment strategies that exist today, the cancer mortality rate would decline by 30% to 50%.

These statistics are profound and strongly suggest that concerted efforts from employers and individuals to encourage cancer prevention and early detection would improve health and reduce health-care costs. Today, our best tool to achieve this is screening. Adherence to recommended screening guidelines — like those published by ACS — could save the U.S. health-care system $26 billion per year in avoided treatment costs.

Despite the importance of early detection and proven value of screening, access to preventive care remains a barrier to better outcomes. At present, a staggering 65% of eligible Americans are out-of-date with recommended cancer screenings. Covid-19 restrictions delayed or prevented 9.4 million cancer screenings in 2020 alone, likely leading to later-stage diagnoses that would have normally been caught earlier.

There are also logistical and societal barriers that contribute to financial toxicities and impact a person’s ability to get screened. People may need to take time off work or arrange childcare to attend a screening appointment. They may need to weigh potential future treatment costs against their need to pay rent. Some may not be aware they’re eligible for screening, and stigma and fear associated with cancer screening hinders some people from seeking care. Inequities according to one’s socioeconomic status — including where they live, their income, education level, access to healthcare and healthy foods, and other social determinants of health — create roadblocks to preventive care. To realize the benefits of early detection on individuals and organizations, it’s important that we develop new strategies to remove these barriers.

ACS is committed to tackling cancer, approaching the challenge of improving access to care and reducing financial toxicity from multiple angles. Similar or supportive action from U.S. employers will increase our collective impact against cancer’s burden.

Toward the goal of increasing early detection, ACS recently partnered with Color Health in a joint venture to improve access to screening and preventive care through employers and unions. By making it easier and more convenient for employees to get care — with at-home testing kits and care navigation support across their cancer journey — this program aims to increase awareness, accessibility, and affordability of cancer screening and early detection. Notably, organizations taking advantage of the ACS-Color program have witnessed a 77% increase in cancer screening adherence.

In addition to direct screening initiatives, programs like Road to Recovery and ACS Hope Lodges remove the cost burdens of transportation and lodging for cancer treatment. Other partnerships through BrightEdge, ACS’s donor-funded innovation and investment arm, provide access to a wide range of solutions that help people navigate the financial complexities of cancer across the continuum of care. One BrightEdge portfolio company, TailorMed, offers a platform to help patients find resources to cover the cost of treatment and reduce out-of-pocket expenses. Further investments aim to bring the patient voice into therapy and diagnostic development, to enable a future generation of sustainable cancer innovations that reduce patients’ financial distress.

Advocacy is also key to reducing financial toxicity. ACS’s Cancer Action Network advocates for Medicaid expansion to help currently uninsured individuals access screening and preventive care. To bring down the cost of prescription drugs, ACS CAN has also successfully advocated for “smoothing,” a policy that allows Medicare beneficiaries to spread out their prescription drug costs over the course of the year. By making payments more manageable for patients, we remove a crucial element of the cancer financial challenge.

Cancer will impact one in two women and one in three men at some point in their lifetime. By facilitating guideline-recommended screening and activating programs that make early detection affordable and accessible, employers can offset financial toxicities and improve outcomes for people across the country. When employers help their employees get screened, they bring us one step closer to ending cancer — and its costs — as we know it.

—By Karen Knudsen, CEO of the American Cancer Society (ACS) and the American Cancer Society Cancer Action Network (ACS CAN). She is also a member of the CNBC CEO Council.