Some cancer patients may forgo care due to high treatment-related costs: report

Since Natalie Lipschultz was diagnosed with stage three colorectal cancer in 2019, she estimates the illness has cost her more than $20,000 in out-of-pocket expenses.

Several months after her diagnosis, the Burnaby, B.C., resident was terminated from her job at an insurance company without cause while undergoing chemotherapy in January 2020. She agreed not to pursue legal action in exchange for her health benefits and severance.

Lipschultz, who was 34 at the time, had tried to balance work and treatment, answering emails on her laptop during chemotherapy.

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Looking back, she wishes she had focused more on her body.

"The health-care system failed me, my work at the time failed me, and I'm gonna get a little emotional, but I think I failed myself a little bit too," she says.

Her story embodies the findings of a Canadian Cancer Society report, published Monday in partnership with Statistics Canada and the Public Health Agency of Canada with analysis by Canadian Partnership Against Cancer, on the economic cost of cancer-- for the health-care system, but also for the patient.

The report estimates a cancer patient will face almost $33,000 on average in out-of-pocket cancer-related costs in their lifetime, including loss of income.

While Canada's publicly funded health-care system covers hospital costs including chemotherapy and radiation, patients still pay for some prescription drugs and travel expenses. There is also the cost of lost time going to appointments, and lost income during treatment and recovery.

Physicians and health policy experts say these costs make navigating a complex disease even more challenging -- disproportionately affecting lower and fixed-income patients as well as those in rural and remote communities far from cancer treatment.

The report cites studies that show the financial burden of cancer may also affect health outcomes. For instance, some may opt out or delay treatment because they can't take time off work, pay for travel and accommodation to get care in another city, or afford a nutritious diet and healthy lifestyle. Advocates suggest federal and provincial governments should step in to help close the equity gap.

The report projects cancer in Canada is expected to cost $37.7 billion for health systems and for people with cancer and their caregivers in 2024. The health-care system pays for 80 per cent of those costs -- just over $30 billion -- and patients shoulder $7.5 billion, about 20 per cent.

Out-of-pocket costs for cancer patients and caregivers are projected to increase by almost 20 per cent over the next decade, due in part to population growth, aging and better cancer survival rates, which the report says could widen the gap between those who can afford to pay -- and those who cannot.

A Canadian cancer study published in Current Oncology in 2024 shows patients with family incomes of less than $50,000 per year are more likely to forgo care and report increased financial hardship. These patients reported spending an average of 34 per cent of their monthly income on cancer-related costs.

In this respect, Lipschultz considered herself fortunate. She had family and friends to lean on for financial support when she was in treatment and could take public transit from her home in Burnaby to a Vancouver cancer centre.

In 2022, her cancer returned, metastasizing to her liver, classified as stage 4. Her mother stepped in to help care for her five-month-old daughter.

"If we didn't have that support system to lean on, I don't really know what we would have done," she said.

At the time, Lipschultz was on maternity leave at a new insurance brokerage. "We were already kind of struggling financially with even just the maternity leave pay. Then if I had to transition to, say, a long-term disability, it's still only a percentage of your salary. So although you do still keep your benefits, there's a lot of things to really think about."

Like Lipschultz, about 60 per cent of people in Canada have private health insurance, most often through an employment benefit. But reducing work hours or leaving a job to manage an illness could risk losing that coverage.

As a result, Jennifer Gillis, director of surveillance for the cancer society, said patients are faced with difficult decisions "with some individuals having to decide between their expenses like rent, mortgage payments and expenses that might come up that aren't covered, such as prescription drugs."

Costs associated with travel time can also impact a patient's treatment decisions. A Canadian Partnership Against Cancer report in 2014 found breast cancer patients with longer trips to radiation facilities were much more likely to choose to have a full mastectomy over a breast-conserving surgery with followup appointments. Recent research in the U.S. and Sweden reinforced these findings.

At St. Michael's Hospital in downtown Toronto, Dr. Lisa Hicks, a malignant hematologist, says she sees the "enormous" emotional burden that financial stress puts on some of her patients.

Hicks treats blood cancer patients, which requires one of the longest and most complex treatments, including stem cell transplants. She says it's a full-time job.

"Imagine a new job that doesn't pay," Hicks said.

She said even patients living in the city, particularly those dependent on wheel trans or who don't drive, find it difficult to make it to one or two appointments a week.

Claire de Oliveira, an associate professor at University of Toronto's Dalla Lana School of Public Health, says provincial governments should explore what can be done to ensure patients are not forgoing the care that they need.

"There are some really high out-of-pocket costs for some cancer patients and that could be a barrier to access care -- so what can we do to address that?"

The cancer society says national drug coverage for take-home cancer medications could help bring down out-of-pocket costs for patients, and address disparities in access to these drugs.

On average, 70 per cent of cancer drugs are covered by provincial programs in Canada. Take-home oncology medications are fully covered in Manitoba, Saskatchewan, Alberta, and British Columbia, but not in Ontario and Atlantic Canada, according to the federal government's website. Quebec provides coverage, but some patients have to pay a deductible based on income.

Stephen Piazza, director of advocacy at the cancer society, says, "We're calling for take-home cancer drugs to be covered no matter where you live in Canada."

Travel and accommodation funds are also a patchwork that should be offered consistently across the country, says Piazza.

At a federal level, he says the governments should modify the caregiver tax credit, which currently doesn't apply to people who can't work while taking care of someone with cancer or another serious illness full-time.

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Today at almost 40 years old, Lipschultz is cancer-free, but if her illness returns, she says she would need specialized drugs that would cost more than $10,000 a month, and are not covered by private or provincial health insurance.

She says she wants health care ministers and decision-makers to acknowledge not only what cancer patients go through emotionally -- but financially, too.

"We still need to work. We still, a lot of times, have mortgage payments, we have young kids we have to think about. We have so much more cost, so much more emotional burden. And, you know, let's be honest, we're trying to live a very long time and all the costs are really gonna add up over the next, you know, 20, 30, 40 years, and we're hoping to get there."

This report by The Canadian Press was first published Dec. 9, 2024.

Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.