Posted on 08/02/2025 11:07:47 AM PDT by nickcarraway
Stage IV patients paid over $700 more per month in the initial 6 months post-diagnosis
A diagnosis of cancer brings substantially higher out-of-pocket costs (OOPCs) for privately insured patients, particularly those with more advanced cancer, researchers found.
In a cohort of more than 46,000 patients, an incident cancer diagnosis was associated with a mean increase in OOPCs of $592.53 per month in the 6 months after diagnosis, reported Liam Rose, PhD, of the Stanford University School of Medicine in Palo Alto, California, and colleagues.
This finding "underscores the financial burden of cancer care on patients with insurance who are not yet eligible for Medicare," wrote Rose and colleagues in JAMA Network Openopens in a new tab or window. "Our findings provide quantitative evidence that even with private insurance, OOPCs were higher in the month of diagnosis and in the months after diagnoses compared with costs for a control group."
Among patients grouped by stage at diagnosis, the authors found no significant difference in monthly OOPCs before diagnosis. However, for the 6 months after diagnosis, the mean OOPC increase ranged from $462.01 per month for patients with stage 0 cancers to $719.97 per month for patients with stage IV cancers.
Differences in OOPCs between individuals with or without cancer were much greater in the month of diagnosis and decreased in the months after.
For example, the OOPC difference between cancer patients with stage 0 disease and non-cancer patients was $1,360.80 at diagnosis, $229.26 at 3 months after diagnosis, and $10.10 at 6 months. The OOPC difference between cancer patients with stage IV disease and individuals without cancer was $2,276.37 at diagnosis, $338.34 at 3 months, and $299.61 at 6 months.
"This result seems straightforward," Rose and colleagues wrote. "Later-stage disease is associated with more intensive workup and treatment that can drive higher medical expenditures. However, this result has not previously been empirically demonstrated, to our knowledge."
This cohort study used Optum administrative claims data of a large insurer linked to the Surveillance, Epidemiology, and End Results cancer registry. The study included individuals living in the U.S. from 2008 to 2022 who were under age 65 years, insured through a large national private health insurer, and had 6 or more months of continuous enrollment.
Patients were excluded if they were enrolled in a Medicare Advantage plan at any time during their enrollment in Optum, had no associated medical claims, or were missing cancer stage.
The 46,158-patient study population was two-thirds female, over two-thirds white, 8.9% Black, 7.8% Hispanic, and 5.5% Asian. The cohort included 19,656 patients with cancer (42.6%) and 26,502 patients without cancer (57.4%) as a control group.
About three-fourths of the patients with cancer had breast cancer, while 14.5% had colorectal cancer and 11.4% lung cancer. The mean age at diagnosis was 46 years.
The authors acknowledged the study had several limitations, including that individuals with cancer may be more likely to drop insurance coverage due to mortality, loss of employment, or a desire to change insurance coverage.
Thus, "differential attrition may have biased our estimates upward if a significant portion of the cancer group dropped their insurance coverage shortly after receiving an incident diagnosis," Rose and colleagues observed.
My mother’s late stage cancer treatments cost over $250,000 in two years. We paid $10,000. Insurance saved our bacon, and I don’t worry about amounts that only have three figures in them.
My wife and I are both over 71. If either of us gets cancer, we’ll go holistic. The only thing we’d go to a hospital for is morphine for the last days if it comes to that.
Nobody lives forever. We’ve lived very productive lives and, frankly, I’m personally having the best days of my life. But I’ll meet the Lord at a day of his choosing. And I’ve always seen 70 as the “official” finish line. Even moreso than the rest of my life, I’m living on borrowed time and making the most of it.
Health care in America really is horrible anymore. Gets worse with each year.
Out-of-pocket costs are per services charged. Of course there are more services to a person newly diagnosed and needing follow up.
These numbers don’t seem that expensive to me. Am I missing something?
We today have socialized healthcare in America. We just don't see that because you have private hospital, doctors, insurance, pharma and medical device manufacturers.
But in reality everything is driven by a “standard of care.”. And that standard of care is defined by government. When Obama decided that Gender dysphoria needs covered by health insurance a few years ago, so it became reality.
Insurance only covers the standard of care.
Hospitals and doctors don't deviate from the standard of care since this provides them legal protection when staying in its boundaries.
The DEA defines narcotics, the FDA medical devices, the NIH what procedures and medicine is indicated for what condition... You just get coerced to pay but actually have no control over the money, nor does it matter that you're the one impacted. The true decision makers sit far away from the doctors office where your health care options are explained to you.
You really have the WORST of both worlds in America today.You have socialized health care, but at the MAXIMUM price the market will bear.
That’s a feature not a bug. The worst healthcare now is the sooner they can move on to the next iteration of fully socialized medicine.
fyi, You can do that at home.
I have a brother that had home hospice. It is an end of life decision. No resuscitation. They provide the drugs every week.
Agreed.
I tell people don't worry about insurance ... worry about not being fat, sedentary, and eating a garbage diet. Fixing those three things is your best insurance policy.
you dont go to the hospital for morphine to ease last days.
Hospice comes to you home to oversee your care.
My brother had home hospice. We administered both morphine and,towards the end, methadone.
Obamacare. It’s to die for.
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