Oral Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2017

Money matters: the effects of financial toxicity on treatment compliance (#100)

Kim Hobbs 1
  1. Westmead Hospital, Westmead, NSW, Australia

Although Australian (permanent) residents and citizens are fortunate to enjoy the benefits of a universal public health care system that largely provides care at no cost to the individual, payment and funding anomalies exist that are frequently a source of surprise and distress to patients. Some out of pocket expenses are known and anticipated by patients; others are more subtle and unanticipated.

This presentation will explore the numerous guises in which financial toxicity arises. Obvious costs include parking, gap payments and medication co-payments. Perhaps less obvious is the impact of lost or reduced income for patients and their caregivers throughout active treatment and beyond. Further contributing to this issues is the widening of the income inequality gap in the Australian community. Increasingly, there are ethical dilemmas about access to experimental or unapproved treatments that may be purchased by those with financial means but remain unavailable to those without.

Even more ethically challenging is the growing trend to accessing funds in order to pay for “last resort” therapies which are often unproven. Frequently these are treatments that are available for some conditions but not for others. They may have been touted in the media as “miracle” treatments. Clinicians are placed in the unenviable position of having to discuss costs; indeed sometimes having to decide whether to divulge or withhold information about novel treatments based on the individual’s capacity to pay. Some patients and families are utilising social media channels to raise funds for treatments that may not be supported by their health care providers; often implying that there are discriminatory practices at play in inequitable access to treatments.

Conversely, can the clinician be regarded as colluding in potentially unethical practices if they don’t engage in frank discussion about the value of unproven treatments with patients who are publicly raising funds by donation? Media reports of “cancer breakthroughs” are gaining momentum and social media platforms are becoming ever more creative. How best can clinicians manage these challenging scenarios that require transparent and principled clinical decision-making?