The cancer burden continues to grow globally, including in Canada where it is the leading cause of death, responsible for 28.2% of all premature deaths. Previous estimates show that 43% of all people in Canada are expected to receive a cancer diagnosis in their lifetime.1 This translates to nearly 2 in 5 Canadians being diagnosed with cancer, and 1 in 4 dying from the disease.1 The number of new cancer cases and deaths in Canada is also increasing. According to the latest report by the Canadian Cancer Society (CCS), it is estimated that in 2022, more than 230.000 Canadians will be diagnosed and 85.000 will die from the disease.1 And according to data released by CCS, at the beginning of 2018, over 1.5 million Canadians were living with and beyond cancer, representing almost 1.7 million cancer cases that had been diagnosed in people still alive up to 25 years after their cancer diagnosis.
Cancer poses a substantial health and economic burden on patients, their caregivers, and the healthcare system, given its high incidence (over 230,000 cases per year in 2022), long-term health effects, and rising treatment costs.
In addition to its impact on health, cancer is costly. While the burden is high for our health systems, in 2021 cancer related costs amounted to 18.4 billion, it is even higher for Canadians living with cancer. After incorporating cancer related expenses from the patients’ and families’ perspective, the annual economic burden of cancer in Canada increased by CAD 7.8 billion (almost 50% increase). From a societal perspective (the perspective of the health care system and patients and their families), cancer related costs were 26.2 billion in 2021 with 30% of costs borne directly by patients and their families.2
There is much discussion regarding the cost of cancer, and especially the cost of cancer drugs, however, in order to truly understand the economic burden of cancer in Canada, It is important to conceptualize economic burden as three distinct categories: direct, indirect, and psychosocial.2 Direct costs include items such as hospital care expenditures, physician care and drug expenditures. And have been extensively reported and studied. These costs form the majority of the economic costs related to cancer (see above). Included in the direct costs are the out of pocket costs (OOPCs) for patients, which across all phases of care, were the highest component of patients’ and families’ costs. Indirect costs, which include the monetary losses associated with the time that cancer patients spend in obtaining treatment, loss from not working due to short or long term cancer related disability, and the lost productivity due to premature death.3 In a report conducted by the Public Health Agency of Canada, work related productivity losses due to cancer were estimated to be 586.000.000$ in 2008.4 Subsequently, a review conducted in 2010 identified studies published before 2008 that had estimated wage losses due to cancer and found that newly diagnosed cancers in Canada generated an average wage loss of 3.18 billion per year.3 These studies only included labor market related production losses. Indirect costs were the second largest cost incurred by patients and families. The combined effect of lost income and increased expenditure can pose a significant financial barrier in obtaining cancer care, especially for those in a lower socioeconomic status.5
Psychosocial costs, or quality of life costs, include distress, pain, suffering and other negative experiences associated with cancer. They contribute to the overall economic burden of cancer that patients experience, but remain poorly understood. Psychosocial costs are entirely borne by patients and their families.6 A recent study found most cancer survivors in Canada face ongoing and unmet needs related to psychological (90%), physical (80%), and practical (50%) challenges.7 According to a study, the estimated lifetime costs of the psychosocial burden was approximately 428.689$ CDN using conservative measures, representing two third of the total economic burden associated with a cancer diagnosis.5
source. Dimensions of the psychosocial burden of cancer 5
Gaining a comprehensive understanding of the cancer burden faced by patients and their families is vital to accurately assess the economic impact on society. It is not only necessary for upholding our commitments to patient centered care within the cancer control system but also essential for guiding decision making regarding optimal models of care to support patients throughout their cancer journey. Additionally, this understanding plays a critical role in monitoring any inadvertent shifts in cost that could inadvertently burden patients and impact their overall wellbeing.5 Without a clear comprehension of the cancer burden, the opportunities to make informed policy decisions regarding cancer control are hindered, limiting our ability to provide the best possible care and support to those affected by the disease.
The Canadian Agency for Drugs and Technologies in Health (CADTH) indicates that when conducting economic evaluations from a societal perspective, all relevant costs to the patients, caregivers, and employers must be considered.8 However, lost opportunities (productivity loss) is not reflected as a monetary transaction and psychosocial costs are not properly measured or evaluated in economic models that focus on assessing cost effectiveness and budget impact for health systems.
The burden of cancer is incurred by patients, caregivers, employers, and society as a whole, thus, it is important to have accurate cost estimates. And while those who fund and organize cancer care struggle to provide patients with the latest treatments, given limited financial resources, it is equally important to understand the cost on patients, caregivers, employers and society of not making treatments available to cancer patients who need them.
A thorough understanding of the economic burden of cancer, which includes the direct, indirect and psychosocial costs, can help inform cancer related policies that are not only intended to support cancer patients and their caregivers, but also in creating sustainable and resilient health systems.
KEY POINTS FOR DECISION MAKERS
Economic burden of cancer must include direct, indirect and psychosocial costs associated with cancer
Cancer patients, their families and caregivers bear a considerable indirect cost burden related to cancer care in Canada. Caregivers of pediatric patients, women, younger patients and those who are self-employed face higher indirect costs
Psychosocial costs are entirely borne by patients and their families and account for two thirds of the total economic burden of cancer in canada. Given the high impact, economic evaluations should account for psychosocial costs in the analysis to better inform decision making.
REFERENCES
1. Canadian Cancer Society. Cancer Statistics at a Glance. 2022
2. Pisu M., et al. The out of pocket cost of breast cancer survivors: a review. J Cancer Surviv. April 2010
3. Hopkins RB, et al. Estimating the national wage loss from cancer in Canada. Curr Oncol. April 2010
4. Canada PHAo. Economic burden of illness in Canada 2005–2008. PHAC. 2014
5. Garaszczuk, R. et al. The Economic Burden of Cancer in Canada from a Societal Perspective. Current Oncology. February 2022
6. Essue, BM, Iragorri, N, Fitzgerald, N, de Oliveira, C. The psychosocial cost burden of cancer: A systematic literature review. Psycho-Oncology. August 2020
7. Fitch M, Zomer S, Lockwood G, et al. Experiences of adult cancer survivors in transitions. Support Care Cancer. 2019
8. CADTH. Guidelines for the Economic Evaluation of Health Technologies: Canada — 4th Edition. December 2017
9. de Oliveira C, et al. The economic burden of cancer care in Canada: a population-based cost study. CMAJ Open. January 2018