Cancer-Attributable Costs Are Higher for Black Patients: What Providers Should Know About Financial Toxicity

For older adults, cancer-attributable costs vary with cancer phase, type, and race, according to a study published in the Journal of the National Cancer Institute.

Angela B. Mariotto, Ph.D., from the National Cancer Institute in Bethesda, Maryland, and colleagues used Surveillance, Epidemiology, and End Results-Medicare-linked data to identify individuals aged 66 years and older who were diagnosed with cancer during 2008 to 2019 and matched controls without a cancer history. Cancer-attributable costs were estimated for 2013 to 2019 for initial (first 12 months after diagnosis), continuing, and end-of-life (EOL; final 12 months before death from cancer) phases of care.

The researchers found that the net annualized cancer-attributable medical service costs were highest in the EOL phase, followed by the initial and continuing phases ($121,746, $45,063, and $7,141, respectively). Across all phases, there were increases in oral prescription drug costs, especially in EOL (from $4,823 to $11,620 in 2013 to 2019); after adjustment for inflation, medical service and hospitalization costs remained relatively stable. The highest cost was incurred by acute leukemia and distant-stage cancers. Black individuals and those of other races had higher cancer-attributable costs than white individuals.

“Many advances in cancer treatment introduced in the past decade have been groundbreaking, leading to improved patient outcomes, including survival,” senior author K. Robin Yabroff, Ph.D., from the American Cancer Society in Atlanta, said in a statement. “However, some of these novel treatments are also costly and frequently used in combination and for longer periods, which can lead to substantial increases in overall spending and high out-of-pocket costs for patients and their families.”

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Why Cancer-Attributable Costs May Be Higher for Black Patients

For Black patients, socioeconomic and structural factors can shape cancer treatment and its financial burden.

These include:

• Differences in income and neighborhood-level socioeconomic disadvantage
• Insurance and access to care
• Differences in where patients receive treatment
• Delays in diagnosis or treatment that can lead to more advanced disease
• Transportation, caregiving, and other indirect costs
• Access to newer or expensive therapies

The study itself adjusted for demographic characteristics, comorbidity burden, and area-level socioeconomic status, yet still found cancer-attributable costs among Black patients.

Financial Toxicity Is an Important Part of Cancer Care

Financial toxicity (or financial distress) is defined as the severe money problems and stress that patients can experience from the high cost of medical care. It can often lead patients to skip medication doses, avoid doctor’s appointments, drain their savings, or face bankruptcy, deeply affecting their overall health and quality of life.

Cancer-related financial hardship can be affected by factors such as race and ethnicity, income, employment, insurance, cancer type, disease severity, and treatment.

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When caring for patients navigating cancer, providers can assess for the following to gauge finances:

• Whether patients are struggling with medication costs
• Transportation and appointment-related expenses
• Difficulty paying household or medical bills
• Whether cost is influencing treatment decisions
• Whether patients are skipping or delaying medications

This is particularly relevant when caring for Black cancer survivors. Research shows that Black cancer survivors face significantly higher rates of material, behavioral, and psychological financial hardship than white survivors. These disparities are primarily driven by inequities in baseline household income, neighborhood area deprivation, debt accumulation, and reduced access to comprehensive supportive or mental healthcare.

What Providers Can Do to Reduce Financial Barriers

Below are some practical approaches clinicians can adopt to reduce the financial burden for cancer patients:

• Screen for financial toxicity early rather than waiting for patients to raise cost concerns.
• Refer patients to oncology social workers and financial navigators when available.
• Discuss lower-cost medication options when clinically appropriate.
• Consider transportation, caregiver responsibilities, and missed work when developing treatment plans.
• Incorporate patient goals and preferences when discussing treatment intensity, particularly in advanced disease and end-of-life care.
• Use culturally responsive communication so cost concerns aren’t dismissed as nonadherence.

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