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By Massachusetts Society of Clinical Oncologists
| October 15, 2019
This article is a part of BG BrandLab’s Breast Cancer Special Report, assessing the progress we’ve made in the battle against breast cancer and the barriers that we still need to overcome.
Sandra was 43 years young when she was diagnosed with Stage 2A breast cancer. A busy professional with two teenage daughters, Sandra was overdue for her screening mammogram. Unfortunately, her mammogram revealed an abnormality in the outer quadrant of her left breast. Sandra underwent an ultrasound-guided biopsy which revealed a 1.2 centimeter invasive ductal carcinoma. Sandra was seen by a surgeon and underwent a lumpectomy and sentinel lymph node assessment. She was found to have one lymph node positive for breast cancers, estrogen receptor (ER) positive, and Her2neu negative, which tend to lead to a more favorable outcome. Sandra underwent adjuvant chemotherapy with Adriamycin Cytoxan and Taxol. She then underwent radiation to her left breast and was placed on Tamoxifen for five years. She responded very well to treatment, and she only needed monitoring with annual visits to her primary oncologist. Crisis largely overcome, Sandra persevered and was free to continue her life.
Fifteen years after her disease was treated, Sandra had a recurrence of cancer in her lymph nodes, liver, and lungs. She was 59 years young. Her cancer was biopsied and found to be ER positive and Her2neu negative, confirming recurrence of her old breast cancer, not a new cancer. Sandra was not eligible for a clinical trial at that time; however, research showed that new treatments using oral medications (an aromatase inhibitor and a CK4/6 inhibitor) were very effective and often resulted in prolonged, disease-free survival and a high quality of life.
Although Sandra had excellent comprehensive insurance coverage, it would only pay for 80% of the cost of these expensive, cutting-edge medications. Consequently, at the same time she had learned that she had pervasive, recurring cancer, Sandra was facing the likely possibility of paying a sizeable monthly bill for her medications—a bill she and her family could not afford. This has become a terribly common predicament.
Too often, patients like Sandra are forced to endure financial stress in addition to the anxiety that comes with a cancer diagnosis. The added stress caused by unbearable financial burden is known as financial toxicity. Financial toxicity occurs when the financial factors surrounding patients’ health care negatively jeopardize their treatment and significantly impact their well-being. In Sandra’s case, her financial situation meant that she would not be able to access the cutting-edge medications she needed to survive.
There have been remarkable improvements in all aspects of breast cancer management. It is crucial that all patients have access to these treatments and that we, as a community, break down barriers that could make treatments inaccessible to patients.
Let’s consider Sandra’s situation. While there were effective medications that had been approved by the Food and Drug Administration (FDA) specifically to treat her disease, there was an unaddressed barrier of financial toxicity that made this treatment inaccessible for Sandra, adding unnecessary stress to an already overwhelming situation. Financial toxicity exacerbates an already challenging time for patients and their families, but also for their oncologists, who know how to treat their patients, but are now up against a frustrating truth: The most effective paths forward for their patients’ care and treatment are blocked because of monetary limitations.
Together, oncologists can help remove this barrier to care.
The Massachusetts Society of Clinical Oncologists (MSCO) is a non-profit organization founded in 1985 as an advocacyorganization dedicated to improving cancer care and treatment in Massachusetts. It is recognized by the American Society of Clinical Oncology as the voice for cancer physicians and their patients in the state. One of the ways that MSCO fulfills its mission is by promoting access to vital medications that can be supportive or life-giving. Patients’ access to treatment is one of the essential aspects of improving cancer care in Massachusetts. Many of the articles in this report underscore the importance of cancer research and how we are moving closer to a cure. Yet, cancer patients in the Commonwealth (and throughout the United States) will not benefit from these developments in cancer care unless we remove barriers that stand in their way.
MSCO has worked diligently with insurance companies, pharmaceutical companies, and legislators to promote access to these vital medications and to break down barriers like financial toxicity. Over this past year, MSCO has been active in monitoring and engaging in legislation that may affect these issues. One of the most pressing issues concerns copayment assistance legislation. Copayments are the portions of a drug cost that patients pay out-of-pocket. These costs can be significant for some cancer medications and cause significant financial toxicity and stress.
Massachusetts enacted legislation in 2013, the last state to do so, allowing pharmaceutical companies to provide copayment assistance to patients taking a covered non-generic drug. However, this program is set to expire at the end of 2019. At the direction of the Legislature, the state’s Health Policy Commission is reviewing the program. MSCO continues to monitor the review process and will continue to support this program.
As we all know, the cost of medications is a concern for everyone. There needs to be responsible legislation at the federal level to rein in these costs and make medications more affordable. This is a complex issue, and MSCO works with our national association (the American Society of Clinical Oncology) to support it. However, as these issues are undergoing discussion, we must do everything we can to make sure these medications—which our research here in Massachusetts has found to be life-altering in many good ways—remain accessible to all, and that obtaining these mediations does not come with risks of additional stresses that can affect a patient and her family in an already stressful situation.
With the copay assistance program in Massachusetts, a patient like Sandra, who qualifies for this program, would be able to get her medication without added financial burden. MSCO will continue to work with oncologists, legislators, insurance companies, and pharmaceutical companies to provide information and recommendations that will help keep life-changing medications in the hands of the patients who can benefit from the tremendous work of our researchers, scientists, and providers here in Massachusetts.