Combating Canada’s Cancer Care Financial Burden
TL/DR –
Cancer patients in Canada face significant financial burdens, with direct and indirect costs contributing to poor health outcomes, particularly for those with low incomes. Direct costs include cancer treatment such as outpatient medications not publicly funded, with variation by province, while indirect costs encompass loss of income and costs related to travel, home modifications, child care and caregiving. To mitigate these financial burdens, efforts should be made on multiple levels, involving the patient, care centre, and government, and could include improving benefit plans, implementing measurement tools to identify at-risk patients, offering navigation services for public benefit programs, and providing free or low-cost transportation and parking at care centres.
Understanding Cancer’s Financial Impact on Canadians
In Canada, the financial burden of cancer diagnosis, both direct and indirect, impacts many individuals and can potentially lead to poor health outcomes. This financial strain, known as financial toxicity, is recognized as a significant risk factor for health and cancer outcomes. The people most affected are those in the lower-income bracket.
Although the Canadian health care system offers free primary and hospital care, cancer patients often encounter substantial out-of-pocket expenses. Costs include cancer drugs, home medical equipment, home care, and nutritional supplements. Canada’s health care system does not publicly fund these expenses, and the costs can vary dramatically by province.
Public funding for take-home cancer drugs differs by region, ranging from 64% in Prince Edward Island to 94% in Saskatchewan. About 60% of Canadians have private insurance, but these plans often have maximum payouts and require deductibles or copayments. Consequently, many cancer patients bear partial or full medication costs, averaging $6000 per month for non-funded take-home cancer drugs.
Aside from expenses for drugs, equipment, and home care, a cancer diagnosis often results in loss of employment or reduced income. Additionally, costs related to travel for treatment, home modifications, and child care increase. On average, self-employed and employed cancer patients see reductions in earnings of 43% and 24%, respectively, in the first year after diagnosis.
Financial Support for Canadian Cancer Patients
Increasing access to publicly funded drugs, comprehensive federal, and provincial policies on home care and medical equipment costs could mitigate cancer-related financial toxicity. However, the existing support often falls short. Many patients must rely on publicly funded benefit programs such as Employment Insurance (EI) sickness benefits. The EI program provides 26 weeks of coverage, often not enough to cover the duration and complexity of cancer treatments. Expanding the requirements for the Canadian Pension Plan (CPP) disability benefit could provide an income to cancer patients whose symptoms or treatments prevent them from returning to work within the EI sickness benefit program’s 26-week window.
Cancer care centres offer potential solutions for financial toxicity by implementing measurement tools like the Patient Self-Administered Financial Effects questionnaire (P-SAFE) and the Comprehensive Score for Financial Toxicity (COST). These measures identify at-risk patients and connect them with supports and resources. Also, free or low-cost transportation and parking at care centres can help alleviate some out-of-pocket expenses.
Financial toxicity is a significant issue in Canadian cancer care due to rising cancer incidences, high costs of novel cancer treatments, and the increasing cost of living. Those on low incomes are at the greatest risk. To alleviate this, health system innovation and transformation should address the need for better financial support for cancer patients and their families.
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