Recently, investigators at the University of Chicago and Northwestern University reported on a new tool, COST, for measuring patients’ concerns about the financial burden of cancer treatment. The acronym stands for “COmprehensive Score for financial Toxicity.”
Talking about money is not an easy thing for some doctors, including oncologists. Many hesitate to bring up the subject, either out of ignorance about pricing, time constraints, lack of concern, a simple or idealistic disdain for the topic… But the unfortunate reality is that as things stand in 2014, U.S. insurance plans vary in what treatments they cover. A cancer diagnosis can lead to financial hardship and even bankruptcy.
Just think of the first season of Breaking Bad, when Mr. White’s lung cancer diagnosis leads him to a life of crime. Nominally, and part-truly, the chemistry teacher’s motivation to cook and sell methamphetamine comes from wanting to pay his medical bills without accepting charity from friends, and from wanting to leave money for his wife and kids, including a disabled son, so they might live well, or at least comfortably, after his death.
This sort of concern, about the financial toxicity of having cancer, is understandable. And it’s unfortunately common. A recent poll by Harvard’s School of Public Health, NPR and the Robert Wood Johnson Foundation found that medical problems are a major contributor to stress among U.S. adults (which, in turn, leads to more health problems). It’s a toxic cycle. Cancer, like any chronic illness, can cause financial distress. Even among insured patients, out-of-pocket expenses can limit patients’ well-being, leisure activities, family plans and happiness. The problem is nothing for doctors to scoff at.
I used to think that physicians shouldn’t talk about money with their patients because that sort of conversation has the potential to demean the relationship. It can render doctors’ work like an ordinary business transaction, which IMO medical care should never be. But I’m persuaded that as long as we have a largely private, insurance-based health care system, we – doctors and patients – need to talk about how much cancer treatments might cost.
As things stand, adults should have the opportunity to weigh the potential costs of their care in the context of the limits of their insurance coverage, savings and other aspects of their lives, such as responsibilities for paying a mortgage or rent, their kids’ college tuition, whatever it is they might otherwise choose to do what they’ve got, which is finite.
Getting back to the paper out of Chicago…The gist of COST is that it’s a Patient-Reported Outcome Measure (PROM) that might give doctors a better way to gauge patients’ financial concerns and, with that, broach the subject. Which sounds good, terrific. Except that ultimately it’s about money and not really about cancer care.
I’m skeptical, as I am about most checkbox-type measurements of humans’ feelings and worries. And I wonder if the authors’ goal is, partly – but with good intention, of course, and fairly enough, as most doctors need go about their work and earn a living – to secure funding to accomplish more research about COST, which would then be used to predict more cancer patients’ financial stress and concerns in the future. And then we’ll have an even greater cycle of subjective measurements, and researchers collecting data and publishing those findings, rather than just evaluating and providing better medical treatments to more people who have cancer and other conditions, carefully and thoughtfully.
