Most ovarian cancer patients receive a standard, two-step treatment plan, but the cost of these treatments are anything but standard.
Standard Treatment: Surgery & Adjuvant Chemotherapy
After diagnosis, patients usually undergo a surgical operation, known variously as “debulking” or “cytoreduction,” which is meant to physically remove as much of the cancer as possible. Following surgery, patients are generally placed on “adjuvant” chemotherapy, a combination of drugs that can destroy any remaining cancer cells.
Most patients will receive two drugs at this point, a platinum-based chemo agent, like carboplatin, and a taxane, like paclitaxel or docetaxel. While some patients receive intraperitoneal chemotherapy, in which the drugs are administered through a tube inserted into the abdominal cavity, most women with ovarian cancer are given systemic chemo, a pill or infusion that effectively works throughout the body. Women generally receive 3 to 6 cycles of chemo, according to the American Cancer Society.
While ovarian cancer often seems to “go away” after an initial cycle of chemotherapy, around 70% of patients will experience a recurrence at some point, and require one or more new cycles of chemo.
Costs Of Treatment – A Case Study
Treatment costs can pile up quickly and, while most insurance companies will cover at least a portion of a patient’s appointments, surgeries and chemotherapy drugs, almost everyone will inevitably end up dealing with deductibles, co-pays and medication costs.
Treating Ovarian Cancer In Kentucky
Health care costs, for that matter, vary widely, not only by state, but within state. Two different hospitals in the same county can charge drastically different sums for the same operation or therapy. Unfortunately, few researchers have looked into the financial burden of cancer treatment on a regional basis, choosing instead to conduct wide national surveys that can obscure the differences in health care costs between communities.
In their 2016 study, published by Current Women’s Health Reviews, researchers from Kentucky compared the cost of treatment and survival outcomes for 100 patients who had all been diagnosed with stage 3 epithelial ovarian cancer. These patients represented the typical ovarian cancer patient very well; more than 60% of women receive their diagnosis after the malignancy has spread from the ovaries, placing them in either stage 3 or stage 4.
Moreover, each of the 100 patients received the standard treatment regimen we discussed earlier. First, patients underwent a surgical operation, intended to “debulk” tumors disseminated throughout the abdomen and pelvis. After surgery, they received at least 6 cycles of chemotherapy, infusions that combined a platinum-based chemo agent, like carboplatin, with a taxane drug, paclitaxel.
On average, the women paid $211,940 each for their treatments, with costs breaking down along the following lines:
- $127,365 for hospital charges
- $57,597 for pharmacy charges
- $26,978 for physician charges
But are health care costs in Kentucky representative of those in other states? If anything, the state’s health spending is low relative to other regions of the US. In 2009, we spent an average of $6,909 per person for health care nationwide. The state of Kentucky spent a relatively low $6,596 per resident that year.
Obviously, cancer is an extremely expensive condition. But that study didn’t even take the “hidden costs” of malignancy into account, expenses like increased child care, transportation costs and the very real decrease in quality of life that most cancer patients will suffer.
Programs For Low-Income & Uninsured Patients
Nor did it account for the costs to patients who don’t have insurance, still around 11% of the “nonelderly” population, according to the Kaiser Family Foundation. Since insurance companies aggressively negotiate the costs of care, uninsured patients can expect to pay around twice as much for doctor’s appointments and more than 40 times as much for chemotherapy treatments as their insured counterparts.
An estimated 25% of patients making less than $40,000 per year choose to forego a recommended cancer treatment due to the cost, according to this 2010 survey. 52% of the respondents reported spending more out-of-pocket than they had expected to.
Some low-income patients, though, may be eligible for help through state programs, like the Delaware Cancer Treatment Program, which offers uninsured residents who make less than 650% of the federal poverty line (around $74,685 for an individual in 2016) up to two years of free cancer treatment. Georgia has a program which reimburses treatment centers who provide care to uninsured residents with incomes at or below 300% of the federal poverty line.
You can find more information on financial assistance programs in your area by visiting the Cancer Financial Assistance Coalition.
Treatment Costs Under Medicare
In a new study, published in April of 2016 by the Journal of the National Comprehensive Cancer Network, researchers at the University of Washington looked at how much treating ovarian cancer cost for Medicare patients diagnosed between 1995 and 2007.
Analyzing the medical records of 9,491 women aged 65 or older, the standard treatment of cytoreductive surgery and at least six cycles of adjuvant chemotherapy cost an average of $85,987 annually. Non-standard treatments cost around $7,000 more per year.
Since patients with either Medicare Part A or Part B can expect to pay around 20% of their cancer treatment costs after meeting a deductible, we can estimate that each patient receiving standard care would have been required to pay about $17,197 out-of-pocket, not including a deductible or copay. That number, though, is only in 2009 dollars. Adjusted for inflation to 2016 dollars, a patient could expect to pay an average of $19,088.
But again, are these patients representative of women diagnosed with ovarian cancer? In actuality, they’re not far off. 63 is the median age at which women are diagnosed with ovarian cancer. In other words, half of women diagnosed are younger than 63 and half are older than 63. Looking deeper, around 45% of patients are diagnosed between the ages of 65 and 84, and nearly 93% of these women are covered by Medicare, according to the Administration on Aging.
Family & Friends
Researchers have also looked into the financial burden a cancer diagnosis can place on families. During and after treatment, “informal caregivers,” family members and friends, take valuable time out of their normal daily routines to provide emotional support, practical help and medical care for their loved ones.
In 2006, economists at the National Cancer Institute found that during a 2-year period, the average “informal caregiver” spent 8.3 hours per day assisting a cancer patient, taking time off work that amounted to $66,210 for loved ones helping patients with ovarian cancer.