Patti Tyree was afraid that cancer would steal her future. Instead, the cost of treating it has.
She had hoped to buy a small farm with money inherited from her mother. But copayments for just one $18,000 round of breast chemotherapy and one shot of a nearly $15,000 blood-boosting drug cost her $2,000.
Bills for other treatments are still coming, and almost half of her $25,000 inheritance is gone.
“I supposedly have pretty good insurance,’’ said Tyree, 57, a recently retired federal worker who lives near Roanoke, Va. “How can anybody afford this?’’
Forty years after the National Cancer Act launched the “war on cancer,’’ the fight is not just finding cures and better treatments but also being able to afford them.
New drugs often cost $100,000 or more a year. Patients are being put on them sooner in the course of their illness and for a longer time - sometimes for the rest of their lives. The latest trend is to use these drugs in combination, guided by genetic tests that allow more personalized treatment but also add to its expense.
It is not just drugs: Radiation treatment is becoming more high-tech, and each leap in technology has brought a quantum leap in expense. Proton therapy is an example - it costs twice as much as conventional radiation and is attracting prostate cancer patients despite a lack of evidence that it is any better.
The financial strain is showing: Some programs that help people pay their bills have seen a rise in requests, and medical bills are a leading cause of bankruptcies.
“Patients have to pay more for their premiums, more for their copayments, more for their deductibles. It’s become harder to afford what we have, and what we have is becoming not only more costly but also complex,’’ said Dr. Michael Hassett, a cancer specialist and policy researcher at Dana-Farber Cancer Institute in Boston.
Insurers also are being squeezed by laws that require coverage and restrict premiums. And the burden is growing on Medicare, which in some cases pays for treatments and tests not shown to benefit patients.
Why have costs escalated so much? To some extent, it is the price of success.
Cancer deaths have been declining in America since the early 1990s. Two out of 3 people now live at least five years after a cancer diagnosis, up from 1 of 2 in the ’70s, says the American Society of Clinical Oncology.
Nine out of 10 women with early-stage breast cancer are alive five years later and are probably cured.
Treatments now have fewer side effects and let patients have a greater quality of life than chemotherapy did before. But they are far more toxic financially.
Of the nation’s 10 most expensive medical conditions, cancer has the highest per-person price. The total cost of treating cancer in the United States rose from about $95.5 billion in 2000 to $124.6 billion in 2010, the National Cancer Institute estimates. The true tab is higher - the agency bases its estimates on average costs from 2001-2006, before many expensive treatments emerged.
Cancer costs are projected to reach $158 billion, in 2010 dollars, by the year 2020, because of a growing population of older people who are more likely to develop cancer.
That is the societal cost. For individual patients, costs can vary widely even for the same drug. Dr. Bruce Roth, a cancer specialist at Washington University in St. Louis, tells of Zytiga, a prostate cancer medicine approved last year. It costs $6,100 a month and insurers differ on how much they cover.
“I’ve had one patient pay $1.50 copay a month and another patient be quoted $5,943,’’ Roth said. Now whenever he hears about a promising new cancer drug, he worries it will be another case “where finances end up determining who gets it.’’
Tyree, the woman from Virginia, said the hospital billed her insurer $14,865 for Neulasta, a shot to boost white blood cells and help her tolerate chemotherapy. Several cancer specialists said Neulasta usually costs less than half that amount.
The worst part: A much cheaper alternative is available - a different formulation of Neulasta - but many patients are not offered that option.
There’s even a cheaper way to get Neulasta, but hospitals make a lot of money giving the shot instead of teaching a patient or a caregiver how to do that.