National Comprehensive Cancer Network

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NCCN Trends™ Highlights: Financial Obligations for Cancer Care

By Sherry L. Ulrich, MBA, Market Insights Specialist

Health care costs are projected to continue to rise in the United States, with cancer care-related expenses increasing more rapidly than any other health care sector.1  Although patients may have prescription plans and health insurance, it does not exclude them from out-of-pocket expenses as insurers are passing these increasing costs to enrollees through cost sharing (deductibles, co-payments, and coinsurance), leaving patients with cancer having to bear additional financial burden as well as stress.2

With that in mind, patients are increasingly being forced to make difficult choices including, but not limited to, whether or not to postpone or even forego treatment; whether or not to have prescriptions filled or avoid having testing done; and deciding to reduce spending on other necessities.3 Ultimately, these decisions may lead to negative impacts on quality of life and treatment outcomes.2

In December 2013, the National Comprehensive Cancer Network® (NCCN®) conducted an NCCN Trends™ survey regarding patients’ financial obligations for oral cancer agents. Sixty-three percent of respondents noted that, to their knowledge, only half or fewer of their patients are able to meet their financial obligations when it comes to their oral cancer agents.

To your knowledge, how often are your patients able to meet their financial obligations (co-pays, co-insurance) tied to their oral cancer agents? 

Although the survey question was directed to clinicians, a similar finding was seen when Zullig, et al surveyed patients with cancer and found that, although most had prescription coverage and health insurance, nearly half were non-adherent to their prescribed medications due to cost.2,4

Another NCCN Trends™ survey, conducted in March 2014, explored patients’ needs to change drug plans due to inability to pay their co-payments.  Nearly 60% of respondents said that more than 5% of their patients required regimen changes due to inability to make their co-payments, with another 15% of respondents answering that they “Don’t know.”

Currently, what percent of your patients require regimen changes due to their inability to make their co-payment? (no cash, insurance, or foundation/hospital support)?


Survey participants were also asked the frequency with which patient drug treatment plans in their practice had to be changed due to inadequate co-payment funding.  When comparing two years ago (2012) to today, there was an increase of 8% that responded that they “Frequently” or “Very frequently” need to make changes.

Please identify how frequently patients’ drug treatment plans have had to be changed because of inadequate patient co-pay funding (insufficient cash, no supplemental insurance, or unable to find patient support from the pharmaceutical company, foundations, or the hospital). (Select one per row)

In summary, patients today are facing a variety of concerns when confronting cancer, not only regarding treatment decisions, but also how to then access and pay for their prescribed regimens.    

Additional Resources:

The oncology reimbursement landscape continues to present ever-evolving challenges for clinicians and others that work with patients with cancer. As a response to these ongoing challenges, help is available through the NCCN Virtual Reimbursement Resource Room. For additional information, please visit:

On November 3, 2014, NCCN will be hosting its 5th Annual Patient Advocacy Summit: Patient Concerns in 2014 – Big Data, Access, and Palliative Care. Topics for discussion at the Summit include the patient role and experience in big data collection and utilization, how patients are accessing and paying for drugs and biologics in the current political and regulatory environment, and an assortment of issues within palliative care. For additional information and to register, please visit:


NCCN Trends Surveys & Data

NCCN Trends is a survey-based analytics tool from NCCN that focuses on how clinicians in the United States and abroad deliver cancer care. NCCN Trends Surveys pose questions regarding topics including, but not limited to, patterns of care and awareness and utilization of various treatment modalities, as well as key topics impacting oncology stakeholders, such as how changes in the health care environment impact them and their patients.

Data is gathered through brief electronic surveys to more than 154,000 health care providers who access on a frequent basis and express interest in responding to NCCN Trends Surveys. These clinicians consist of practicing physicians in diverse practice settings, including academic/research cancer centers, community hospitals, and private practices. Survey participants also represent pharmacists, nurses, and other oncology stakeholders. In 2013, NCCN conducted 12 NCCN Trends Surveys, averaging more than 1,100 clinician respondents per survey.

NCCN TrendsSurveys and Data are independent of any NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) or other NCCN clinical recommendations.


1 Kumar P, Moy B. The Cost of Cancer Care – Balancing Our Duties to Patients Versus Society: Are They Mutually Exclusive?. Oncologist. 2013; 347-349. Accessed July 23, 2014.

2 Zullig LL, Peppercorn JM, Schrag D, Taylor DH, et al. Financial Distress, Use of Cost-Coping Strategies, and Adherence to Prescription Medication Among Patients With Cancer.  J Oncol Pract. 2013; 1-4. doi: 10.1200/JOP.2013.000971

3 Banegas MP, Yabroff KR. Out of Pocket, Out of Sight? An Unmeasured Component of the Burden of Cancer. J Natl Cancer Inst. 2013; 105:252-253. doi: 10.1093/jnci/djs641

4 Felder TM, Bennett CL. Can Patients Afford to Be Adherent to Expensive Oral Cancer Drugs?: Unintended Consequences of Pharmaceutical Development. J Oncol Pract. 9(6s): 64s-66s. doi: 10.1200/JOP.2013.001167