Cancer Costs Hit Young and Poor Hardest: Study

Washington - In a new survey, colon cancer patients younger than 50 and those with low incomes or unemployed were most likely to experience severe financial hardships as a result of the treatments meant to save their lives.

The study of Washington state residents who underwent colon cancer treatment found that compared with older people, patients under age 50 had more than 50-times greater chances of selling or refinancing their homes, having their income drop 20 percent or more, going into debt or having to borrow money from friends and family to meet expenses.

Patients with household incomes below $30,000 were about eight times more likely to face those financial problems than those who were better off.

"I think most oncologists have heard these stories where people are spending a lot on their treatments," said Dr. Veena Shankaran, the study's lead author and an oncologist at the University of Washington. "These anecdotes are things we always hear in clinics and I wanted to get a broader sense of what's going on."

The study also found that most patients didn't discuss the cost of their treatments with their doctors, and some even skipped or refused treatment because of the price tag.

To gauge the financial impact of cancer treatment, Shankaran and her colleagues sent a survey to 555 adults living in various parts of Washington State and diagnosed with advanced colon cancer between 2008 and 2010.

The questionnaire asked about the participants' financial situation, whether or not they had insurance and about their treatments

Of the 284 people who responded, 104 reported at least one serious financial hardship related to their cancer treatment.

Shankaran told Reuters Health that they did not go into this analysis with any specific expectations. But, she added, "To have nearly 40 percent of patients have these major financial changes was quite surprising to us."

They speculate that those groups have less savings and other resources to fall back on when copayments and denied reimbursement claims start adding up.

Another 27 percent of the survey respondents described lesser financial impacts, including having to sell stocks or withdraw from savings or retirement accounts, or experiencing a drop in income of less than 20 percent.

The researchers found a small number of the respondents who skipped or refused treatment because of costs -- about five percent and seven percent, respectively.

In an accompanying editorial in the Journal of Clinical Oncology, Cathy Bradley, a health policy researcher at the Virginia Commonwealth University School of Medicine, in Richmond, says there are several ways for the health care system to avoid financial hardships brought on by cancer treatments.

One long-term strategy would be to invest in prevention, she writes. For immediate action, she says Medicare should be able to negotiate cancer drug prices or pay for the least costly alternative if the outcome is known to be about the same.

Other than that, Bradley says doctors should talk to their patients about costs and how much the patient would be expected to pay.

"They need to understand how much this is going to cost them and their families. They need to make an informed decision," Bradley told Reuters Health.

In her commentary, Bradley notes that eight-weeks of chemotherapy can exceed $30,000.

From their survey, Shankaran and her colleagues found only 42 percent of patients recalled talking about costs with their doctors.

"I think there are a lot of barriers," she said. "People may be embarrassed and they think the doctors shouldn't have to worry about this."

She added that patients may even think doctors might change their treatment recommendation if they mention costs.

"You wished they would have said something, because there are things we can do," Shankaran said.
Bradley believes the problem should be addressed through policy.

"I think this is a policy question, and the individual is caught in the middle… and I don't think there is much they can do about it."

However, Shankaran said, most oncologists have a financial counselor available in their offices and there are also resources available online.

Survey Reveals Alcoholism in Surgeons; Numbers May Be Higer

United States - A survey from the University of Washington revealed approximately 15 percent of surgeons have an alcohol abuse or dependency problem, but those numbers may be higher.

The survey, which was sent out to more than 25,000 surgeons but answered by only 722, showed a correlation between alcohol problems and major medical errors.

The fact only about 29 percent of the surveys were returned concerns Dr. Edward Livingston, a professor at the University of Texas Southwestern Medical Center who was unrelated with the study.

"If you have a low response rate, you don't know if it represents the universe of people you're trying to study because I think the folks who are less likely to respond may have shame and guilt and fear associated with their alcohol abuse and dependence that they don't want to report on the survey," he said.

The study didn't say why alcoholism is more prevalent than the general population, which is estimated at about nine percent, but some factors may be work, lifestyle, mood-related.

U.S. Government-Subsidized Meat Killing Native Americans

By Kelly Grens

United States - Native Americans who often ate processed meat in a can, generically known as "spam" and a common food on reservations, one subsidized by the government -- had a two-fold increased risk of developing diabetes over those who ate little or none, according to a U.S. study.
Native Americans are at especially high risk of developing diabetes, with nearly half having the condition by age 55.

Researchers writing in the American Journal of Clinical Nutrition surveyed 2,000 Native Americans from Arizona, Oklahoma and North and South Dakota to look into potential reasons for the high rate.
"A lot of communities in this study are in very rural areas with limited access to grocery stores... and they want to eat foods that have a long shelf life," said Amanda Fretts, the lead author and a researcher at the University of Washington School of Medicine.

None of the survey participants, whose average age was 35, had diabetes at the start of the study when they answered questions about diet and other health and lifestyle factors.

After five years, a follow-up survey found that 243 people had developed diabetes.
Among the 500 people in the original study group who ate the most canned processed meat, 85 developed diabetes. In contrast, among the 500 people who ate the least amount of "spam," just 44 developed the disease.

Though Spam is a brand-name pork product, the lower-case term is also used to describe any kind of processed, canned meat, Fretts said. Canned meat is available freely to many Native Americans on reservations as part of the U.S. Department of Agriculture's food assistance program.

Fretts and her colleagues found that unprocessed meat did not have the same relationship with diabetes, with people equally likely to develop diabetes regardless of how much hamburger or cuts of pork or beef they ate.

"I think what this study indicates is processed meats should be a priority for reduction (in the diet), especially among American Indians where they can go to food assistance programs and they can get discounted spam," said Dariush Mozaffarian, a professor at the Harvard School of Public Health who was not involved in the study.

Mozaffarian and his colleagues two years ago conducted an analysis that found that processed meats were tied to a 19 percent higher diabetes risk, while unprocessed meats were neutral.

"I think the biggest difference between processed and unprocessed meats is sodium," he said, though he added that there is no clear explanation for the link of processed meats and diabetes.

Fretts and her colleagues noted that the people who ate the most processed meats tended also to be heavier, with larger waistlines, raising the possibility that processed meats contribute to obesity, which raises the risk of diabetes.

In an emailed statement to Reuters Health, The American Meat Institute, which represents companies that process meat, said that "processed meats are a safe and nutritious part of a balanced diet."

Fretts said the study could not prove that eating processed meats was to blame for the increased risk of diabetes.
"I think there needs to be more follow-up," she said.