The Financial Burden of Cancer Care

As a board-certified radiation oncologist, I’m trained to know all about cancer and its physical effects on people. Similarly, as a board-certified hospice and palliative care physician, I am well-versed about the psychosocial and spiritual trials patients go through, especially at the end of life. But a recent study I read stopped me in my tracks with a disturbing finding: Cancer is bankrupting an astounding number of patients.

Adrienne Gilligan, PhD, publishing her research in the American Journal of Medicine, found that 42% of cancer patients deplete their life savings within 2 years of diagnosis. This “financial toxicity” –  arguably every bit as serious as the emotional and physical toxicity associated with cancer treatment – risks forcing far too many cancer patients to make an agonizing choice between almost certain death and overwhelming debt.

The Advisory Board Company, a Washington, DC-based organization that researches best practices in healthcare and other industries, highlighted from Gilligan’s article that “the direct medical costs from cancer exceed $80 billion in the United States. [The authors] cited previous research finding that up to 85% of cancer patients leave the workforce during their initial treatment, and more than 50% of cancer patients at some point experience bankruptcy, house repossession, loss of independence, and breakdowns in their relationships.”

One observation from this research that should be even more concerning for those of us in deep East Texas is that in more vulnerable populations with lower socioeconomic status and clinical factors such as smoking and poorer health – this describes Angelina County and surrounding counties – the risk of asset depletion is even greater. Even for those with health insurance, the researchers wrote, deductibles and copayments for treatment, supportive care, and nonmedical or indirect costs (for example, travel, caregiver time, and lost productivity) may be financially devastating.

I see this financial burden all the time. Monthly, I get a report from my billing office on the bills that patients are not paying despite multiple contacts. Most of the time, these are deductibles and copays that patients – who live paycheck to paycheck and who have no savings to start with – never are going to be able to pay. Sometimes it is the entire bill, in the case of uninsured and indigent patients. As a physician, I really only have two options: send them to a collection agency to harass them and try to get whatever proverbial blood out of the turnip they can, or write them off. That my patients should suffer not only with a cancer diagnosis and treatment side effects but also possible bankruptcy is absurd. I am rightfully appalled and angered that our federal healthcare reimbursement system and the private insurance complex have achieved “cost savings” by placing more and more of the financial burden onto patients, who simply are unable to pay. The bankruptcy monster is always at the door.

Doctors are familiar with the Latin phrase primum non nocere – first, do no harm. The idea is really that we should balance the risks of treatment with the benefits. I imagine when that phrase was coined the author did not have financial harm in mind. Today, it has become one of the most important “risks” when weighed against the hoped for gains of treatment. Unfortunately, the provision of healthcare has become a commodity and providers are reduced to revenue-producing cogs on the wheel in a system that has replaced the patients’ needs with productivity metrics. The profession of medicine is less and less in charge of the provision of medicine.

In spite of this new reality, healthcare providers – doctors, hospitals, etc. – must recognize that the mission of any healthcare organization is first and foremost health, not profit. When profit alone drives healthcare decisions, the cart is before the horse. And forcing patients into bankruptcy with draconian billing and collection policies profits no one (except maybe collection agencies). Accounts that have little chance of being paid need to be written off quickly and completely.

In hospital systems, some critical services – for example, social work, patient navigation, discharge planning – may have no direct link to the bottom line in terms of a reimbursable, codable procedure or office visit, but nonetheless have a profound impact on preventing financial losses by impacting readmission rates and avoidable costs associated with inability to comply with prescribed courses of treatment. In addition, finding sources of payment for patients can bring dollars in that otherwise would not be seen. These services must not only continue, but be expanded.

Ultimately, legislators need to change the way healthcare services are valued and reimbursed so that the increasingly unmanageable financial burden that falls on everyone – even the insured, hardworking folk – doesn’t bankrupt us all. This isn’t about patient responsibility; it is about preventing personal financial catastrophe. And now it’s January with high deductibles and never-ending copays to meet. I’m afraid we are in for a bumpy ride. Happy New Year!

Cattle Baron's Gala Supports Local Cancer Patients

I always look forward to the Pineywoods Cattle Baron's Gala. Not only do I have a good time, I know the money raised is going to a great cause - the American Cancer Society. Unfortunately, there has been recurrent grumbling - from what I hope is an unenlightened minority - that the money raised doesn't stay local. I understand this "local first" mindset and agree that we should expect local return on our charitable giving. The American Cancer Society delivers that in spades.

Yes, the American Cancer Society is a national organization. But did you know that the American Cancer Society has a regional office building right here in Lufkin? This office was built thanks to generous local foundation, business, and individual support. Did you know this office houses eight employees and serves a 12-15 county region? Annual payroll, benefits and overhead is about $450,000 per year. These are good local jobs that feed back into the local economy at a time when all local jobs are significant.

But it isn't just about the jobs. Every dollar raised has local impact in many more ways. Since I started practice in Lufkin nearly 23 years ago, the overall cure rate for cancer has increased from 50% to over 70%. That translates to local lives saved, not in small part due to the incredible research funded by the American Cancer Society. Statistically, an additional 120 people who come through the Temple Cancer Center every year are cured! Now, that is local impact!

Did you know that the American Cancer Society National Cancer Information Center in Austin handles close to 1 million requests for cancer information annually, including calls from Lufkin and deep East Texas? Those calls, emails and online chats provide direct, one-on-one support and information about local services for local patients, including navigation and information on how to access insurance coverage when possible. (By the way, some of these services, like rides for patients to appointments, require local drivers. You can volunteer to help!)

Did you know that every new cancer patient seen in the Temple Cancer receives accurate, specific educational material provided by the American Cancer Society? And local cancer patients have access to wigs, supplies, and support services whether they receive treatment locally or not.

Did you know that the American Cancer Society funds efforts to increase screening rates for cancer? More than 4.6 million women in need have been helped since 1991 through the national breast and cervical cancer early detection program. The latest project is to screen 80% of the eligible population for colorectal cancer by 2018. Colorectal cancer screening can find and remove polyps before they become cancerous, and that prevents colorectal cancer. And what about the incredible American Cancer Society work in the area of tobacco control? Locally, the American Cancer Society Cancer Action Network was instrumental in the passage of smoking ordinances in both Lufkin and Nacogdoches.

What about local patients who choose to travel to the Texas Medical Center for treatment? Soon they will have access to free lodging at Hope Lodge Houston provided by - guess who? - the American Cancer Society. The TLL Temple Foundation generously provided the lead gift for the Hope Lodge Houston. 

What about the various treatments we recommend for cancer patients? Those treatments very well may have been developed from research supported by none other than the American Cancer Society. The American Cancer Society has funded an incredible $4 billion in research grants since 1946. In Texas alone, this year nearly $36 million is currently invested in research.

Website presence? The American Cancer Society's website, cancer.org, is the most trusted website available when it comes to cancer information, with 61 million hits logged in 2014.

The suggestion that funds raised by American Cancer Society events don’t stay local (or don’t benefit our local community) simply can't be supported by facts. Not only that, it misses the point that we can accomplish so much more together than what we can by ourselves. Isn't that our community spirit anyway?

Join me this Saturday night, October 10th, at the Moore Farm for the 2015 Pineywoods Cattle Baron's Gala in support of the American Cancer Society’s lifesaving cancer research, education, and truly local services. Call (936) 634-2940 for ticket information.

New Cancer Fighting Technology in Lufkin

Last week, the Temple Cancer Center treated the first patients on our new Elekta Synergy linear accelerator, the first major investment of Memorial since the CHI acquisition. To say, "We got a new piece of equipment" understates the multi-year project of visiting other cancer centers, evaluating manufacturers, specking options, removing an older treatment machine and renovating the vault that houses the linear accelerator, and determining what other hardware and software is required to make this new piece of incredible technology work to treat cancer. No small task!

All told, this project, which also included a Toshiba large bore CT scanner, Vision RT image guided radiation alignment technology and other accessories, topped out at $4.5 million. It is a recognition of the importance of exceptional cancer treatment to our region and a signal that Memorial will remain the regional hub for cancer care in deep East Texas.

So, what does this new technology bring to our deep East Texas region? For our many patients currently being treated with IMRT - intensity modulated radiation therapy - we will be able to deliver their treatment in a fraction of the time it has taken up until now, often less than five minutes per treatment! Standard treatments can go even faster. And, these treatments are often even more precise with less dose to surrounding normal tissues, which will translate to even fewer side effects.

In addition, we will be able to implement a totally new procedure to the region called SBRT - stereotactic body radiosurgery. SBRT delivers high doses or radiation over very short courses - three to five sessions, typically - and requires much finer tuning and more rapid treatment delivery than we were previously able to do. We will start using this technology for small lung cancers first, but I anticipate over time treating cancers in other locations as well. The utility of the technology for lung cancer cannot be overstated. Lung cancer is almost always related to smoking, and heavy smokers often cannot undergo surgery, because they do not have enough normal lung function to survive removal of even a small part of a lung. However, these same patients can often be cured with SBRT. With low-dose CT lung cancer screening, we anticipate finding more early lung cancer; now we have the ability to treat them even if they cannot have surgery, with equal results and less morbidity.

Another site where we plan to implement stereotactic radiosurgery technology is in the brain, where small tumors can be ablated with radiation without having to be removed neurosurgically. Treating tumors such as these in an outpatient setting without having to resort to major chest or brain surgery is a remarkable benefit of this new technology. We will not start using this new technology immediately, however, because any new procedure requires establishment of appropriate protocols, quality assurance procedures, and training, all of which will be implemented over the coming months.

The Temple Cancer Center is also excited that our social worker, Appolonia Ellis, recently completed the Harold P. Freeman Patient Navigation Program, where she learned how to better assist our patients in accessing available services and programs so that they can successfully complete treatment. Patient navigation is fairly new to cancer programs, and we are excited to have the only navigator in the area.

At a time when other industries have announced plans to cut hundreds of jobs or move out of the area altogether, CHI's long term commitment to Lufkin and the Memorial system is reassuring. They are putting their money where there mouth is, so to speak. For that, I am grateful.