Easing the Patient Burden

FUMIKO CHINO: My name is Fumiko Chino and I’m a treating Radiation Oncologist at Memorial Sloan-Kettering Cancer Center in New York City. And I specialize in the treatment of breast and gynecological cancers. I have a research focus on access, affordability, and equity in cancer care. And my primary research topic is on the financial toxicity of cancer care. The term financial toxicity has really evolved to mean the costs that are borne by patients and the downstream effects of how those are really impacting their lives, their ability to afford their treatments, the sacrifices that patients and their families are having to make, and sometimes the negative consequences in terms of increased symptom burden, uncontrolled disease, and unfortunately, death. We know our patients are making sometimes incredible sacrifices in order to afford their care. They are going into bankruptcy. They may be losing their house. And there can be generational poverty associated with a cancer diagnosis. We know the concept of financial toxicity is not limited to cancer. There are many health states in the United States that are incredibly expensive. We know that people are unable to afford their asthma medication. They’re unable to afford their diabetes medication. But my focus has always been in cancer. One of the growing and evolving research topics here at ASCO, the world’s leading oncology conference, is this concept of administrative burden that we are placing on patients. So let’s say you have a cancer diagnosis and you’re just trying to deal with the treatment and the side effects, and also balancing your family and maybe work. But what we found over time is that because care has become more complex and costly, more and more of these administrative burdens are being placed on patients. So that means that patients may have to file for short-term or long-term disability. They may have to fill out paperwork for FMLA. And they may have to actually make an insurance appeal for their prior authorizations. All of these things are meaningful because they create additional stress and anxiety for our patients. And ultimately if these do not go as planned, they can actually create real and measurable barriers to care. So that may mean a delay of essential cancer treatment. Or it may mean that people have to skip out on treatments altogether. And that actually can lead to, again, worse outcomes for our patients. That could be increased symptom burden or even, again, death. So that is why our focus has always been on trying to improve outcomes. But the shift has been more towards, how do we actually make the lived experience of cancer better? FUMIKO CHINO: So I’m at ASCO, which is the world-leading cancer conference, where 40,000 oncologists and providers that treat cancer are gathered. And what we’re identifying is new and novel treatments for cancer. And that means new drugs or new care delivery plans, but it also means an increasing focus on patient-centered care. So instead of only focusing on drugs, we also want to make sure that the patient experience, so how people are tolerating their treatment, how they’re being able to afford their treatment, and to make sure that they’re actually not just surviving cancer, but thriving after cancer treatment is complete. That’s become a new and evolving focus in our field. And I hope that fitness that extends to all aspects of medicine, not just cancer care, that we’re always focused on what truly makes the patient’s life longer and better.