Can You Afford Your Cancer Care?

A cancer diagnosis is usually a double whammy: The disease itself is daunting, and the cost of treatments is an aftershock. Cancer patients are two and a half times more likely to file for bankruptcy than other Americans, according to a study by the Fred Hutchinson Cancer Research Center in Seattle.

The study found that young people are particularly vulnerable to bankruptcy, especially if they're in the midst of paying off student, house and car loans.

"The biggest problem is that we're now creating an economic disparity between who can afford treatment and who can't," says Scott Ramsey, a physician and health economist at Fred Hutchinson who led the study. Ramsey adds that sometimes patients have stopped therapy because they can't afford it -- and that can be a fatal decision. Leukemia patients who stop taking Gleevec, for example, risk recurrence, which can lead to death.

The heart of the problem, Ramsey adds, is that cancer drugs in the U.S. come with a hefty price tag, with some costing about $10,000 a month, and copays that are 20 to 30 percent of that. So treating cancer costs about 20 percent more than other chronic diseases -- and its costs are increasing the most, Ramsey says. "It's a huge burden right now, especially if patients lose their ability to work. They can lose their insurance if they have to go on disability, and often family members have to take care of them. It's a pretty burdensome disease."

[Read: How to be a Good Patient Wingman.]

Advanced Cancer Most Expensive

While you cannot put a price tag on someone's life, it probably comes at little surprise that the most expensive drugs are those that treat the most advanced forms of cancer -- precisely when people are closest to the risk of death. Provenge, a drug for advanced prostate cancer, costs $100,000 for one treatment, with a copay of 20 percent, says Joanne Lynn, director of the Center for Elder Care and Advanced Illness at the Altarum Institute in the District of Columbia. Lynn adds that the drug has been shown to extend life an average of two months.

"I think a number of people would say that the gamble of two extra months is just not worth it," she says. "It's the kind of question we should be willing to ask."

To that end, Lynn advises physicians to be "brutally honest" with patients about what they are getting. "Very often the treatment for advanced cancer is very expensive for a little bit of gain," she adds. "A lot of patients would say that it really isn't worth it to have an extra month or two and leave [their] family in financial ruin."

However, some treatments for advanced cancers are also mainly used for symptom control and are fairly inexpensive, Lynn adds. "A patient could really press [their physician] for the less expensive drug."

Lynn adds that it's important to consider what life stage you're at when deciding how much you're willing to spend for your care. If you are younger and in your prime, then you might do everything to foot the bill. But, as Lynn points out, "More and more people are getting these illnesses later in life, so it really does depend on what else you are facing." If, for example, you also have dementia and a bad heart, then putting you through chemotherapy might not make sense.

[Read: A Patient's Guide to Second Opinions.]

Know Your Options

"The most important thing for patients to do is be their own advocate to minimize the costs of care," Ramsey says. "Most patients don't realize they have choices." For example, it would cost lung cancer patients thousands of dollars less to take the standard therapy -- Paclitaxel and carboplatin chemotherapy -- than taking newer, targeted drugs such as Tarceva or Crizotinib. While in certain patients the new therapies might be more effective, patients who follow that course "should be prepared for a very high bill. It's a decision that's going to cost thousands and thousands of dollars."

Ramsey also suggests that patients get a financial counselor to help them manage their bills and other expenses when they're newly diagnosed. While such counselors might not be available at all cancer centers, they're at most large cancer centers -- so take advantage of them. "I don't think most people realize what type of burden they are going to face, so they don't make adjustments to their finances."

While the Affordable Care Act may improve the situation somewhat, simply by extending insurance to previously uninsured people, "it's not going to make the problem go away, because some of the plans under the ACA are pretty bare bones," Ramsey says.

And the ACA won't do anything to actually lower the rising costs of the drugs themselves, he adds. While most European countries have price checks -- and health care agencies can negotiate with drug companies to lower prices -- the U.S. lacks such a system. "We've created a system that does not put the brakes on prices. Insurers are responding by turning the burden to patients," Ramsey says. "Now the cost is getting so that the whole structure of insurance is breaking down."

[Read: How to Help Teens Cope With a Parent's Cancer.]

Help Is Out There

Still, patients should not despair. There are resources to help them, adds Kristen Reineke, chief marketing officer at CancerInsurance.com, which provides insurance policies to people who have not been diagnosed with cancer in the past decade -- but who are at high risk of a diagnosis because of family history or genetic predisposition. People who sign onto the insurance end up paying a minimal monthly deductible -- say $15 to $20 -- which offsets costs incurred if illness does strike.

Reineke also outlines a number of other resources available for cancer patients, such as Angel Airline Samaritans, which offers free flights to cancer patients who need to travel for treatments, and cleaning services provided by the nonprofit organization Cleaning for a Reason.

The HealthWell Foundation, a nonprofit that provides assistance to insured patients, can also help people pay for their medications, since that's where many people fall through the cracks, Reineke says.

"It's important that people focus on their recovery and not have to worry about the financial burden," she adds. "These types of resources could help alleviate some of that stress."

[Read: Free Services for Women With Breast Cancer.]

Kristine Crane is a Patient Advice reporter at U.S. News. You can follow her on Twitter, connect with her on LinkedIn or email her at kcrane@usnews.com.