Part 2: The Impact of High Cancer Cost on Patient & Family

When a person is diagnosed with cancer, his/her world is often turned upside down. A cancer diagnosis impacts the patient in various ways:

• Physically – pain, suffering, unable to walk etc.
• Emotionally – how much time do I have? I cannot afford to die yet, my children are still small.
• Financially – generally no one talks about this and the family suffers in silence.

The financial toll of cancer is seldom publicly discussed although it is a very important issue indeed. Is this subject a taboo in our Asian culture?

But let us face reality. Why don’t we discuss this issue and try to understand how to mitigate the impact of this financial burden. So, in the coming weeks/months, I shall be presenting you with a series of articles on this subject.  

Let us examine how cancer impact us financially. There are 4 main costs involved:

1. Consultation and Diagnosis.

Realizing that something is not right, it is important that you go and consult a competent doctor and find out what is exactly wrong with you. So be prepared to pay the following costs:

a. Consultation fee.

b. Blood test.

c. Imaging procedures like ultrasound, mammogram, CT scan, PET scan.

d. Biopsy.

A patient who had breast cancer did the above diagnostic procedures in a private hospital in Penang. It cost her RM 10,817. Take note, this is before any treatment is done yet.

2. Treatment Costs – outpatient and/or hospital stay.

The gold standard of medical treatment for cancer is: Surgery, Radiation and Pharmacological therapy.

Some patients receive all the three treatment modalities, while others receive one or two types.  The cost to the patient vary depending on the type and extent of the treatment.

Some “advanced or modern” hospitals may offer other treatments such as:

• stem cell transplant,
• hyperthermia,
• photodynamic therapy,
• cryotherapy,
• immunotherapy,
• mini-invasive interventional therapy,
• particle implantation or particle knife,
• radiofrequency ablation (RFA),
• photon knife therapy.

The cost of any one of these therapies varies. So it is good to find out your financial obligation. Take note that for treatment in a private hospitals, every item used costs money. Every service provided costs money. Nothing is for free in there. For example:

• You pay for a cotton bud if that item is used.
• You pay a fee for the chair you sit on while undergoing chemotherapy.
• Each time the doctor comes into your room and say “hello”, he/she collects a profession fee.

A patient with prostate cancer was hospitalized for 8.5 days in a private hospital in Kuala Lumpur. The total hospital bills came to RM47,159. Just imagine what the bill would be like if the stay was extended to a month or more? A cool RM200K?

A breast cancer patient underwent a total mastectomy without reconstruction at a private hospital in Hong Kong. The total bill came to HK$257,298 or RM155,139.

So cancer treatment in a private hospital is not cheap!

Drugs for Cancer.

Medication is a very common part of cancer treatment.

• chemotherapy drug,
• targeted therapy drug,
• immunotherapy drug,
• hormone therapy  drug,  
• other drugs for pain, anti-nausea and other complications.

Some of these drugs can be taken as pills while some others are administered intravenously (IV) in a doctor’s office, clinic or hospital.

Some drugs appear to be affordable to the ordinary folks but some others may cost a bomb. For example:

• A lung cancer patient received 24 injections of Imfinzi – an immunotherapy drug. Each injection cost IDR 40 Million or RM12,000. The total cost of 24 injections means IDR 960 Million or RM 288,000. The treatment failed and he came to seek our help.

• A breast cancer patient was told to receive 17 times of immunotherapy treatment after her surgery. Each treatment is going to cost her RM15,000 or a total of RM255,000. Her son said the family does not have that kind of money and gave up.

Generic Drugs from India.

One aspect on cost of chemo drugs that many of us may not know is that, we are lucky and need to grateful to have India and Bangladesh to supply generic chemo drugs for the world. Without these generic drugs the cost of chemotherapy would have shot up sky high!

What are generic drugs? The US-FDA said:

• A generic drug is a medication created to be the same as an already marketed brand-name drug in dosage form, safety, strength, route of administration, quality, performance characteristics, and intended use.

• A generic medicine works in the same way and provides the same clinical benefit as the brand-name medicine. In other words, you can take a generic medicine as an equal substitute for its brand-name counterpart.

According to the Pharma Intelligence Center, as of 26 February 2021, there are currently 1,351 generic drugs available in India for the treatment of various cancers.

According to the US-FDA, generic medications can cost, on average, 80 to 85% less than the brand-name equivalents.  That is a great saving indeed and would help the poor folks of the developing countries. Thank you India!

According to the website  (https://www.clinicspots.com/cost/cancer-surgery/india):

• The average cost of chemotherapy in India is INR Rs. 18,000 per session. This is equivalent to RM1,030.

• The maximum charge for chemotherapy in India is about INR Rs. 50,000. This is equivalent to RM2,862.

• The total costs of chemotherapy vary between INR 138,974 and INR 208,462. This is RM 7,954 and RM11,931.

A lung cancer patient had chemotherapy in one cancer hospital in Penang. The drugs used were:

• Krabeva – a generic form of Avastin
• 5-FU, and
• Irinotecan – a generic by Intas.

He paid (as of August 2022) RM6,738 per cycle. Compare this to the costs in India!

3. Non-medical Cost. Besides the cost of treatment and hospital stay, there are some “invisible” costs such as:

1. Transportation and travel costs. Although the cost of transportation may seem trivial compared to treatment, these expenses can add up quickly, especially if you seek treatment away from your hometown. These costs could include gas, tolls, parking, taxis, bus, train, or airplane fares, besides cost of hotel / apartment and food while away from home.

• Lost wages or income. Some patients must stop working temporarily or permanently, or reduce their work schedules. All these can have serious financial repercussions.

4. Survivorship Care Costs.

We need to know that even when a patient has completed his/her  surgery, radiation and/ or chemotherapy, the costs of care do not end immediately.

Many cancer survivors may have to deal with certain cancer symptoms and the side effects of treatment. That can last for months to years after finishing the treatment – sometimes for the rest of their lives.

The costs may involve:

• Visit to the doctor for regular check-up.
• Some patients may suffer various side-effects, such as fatigue, difficulty in movement or many other symptoms and may need assistance such as:
• supportive or palliative care,
• rehabilitative therapy,
• mental health services,
• nutrition counseling, and
• cardiology consultations as a result of their cancer or treatments.
• Some patients may need to pay for helpers to care for themselves or for their children while at home.