The administrative burden of cancer

A cancer diagnosis is, no doubt, emotionally and mentally overwhelming.

Processing the news is a lot to deal with on its own. Unfortunately, those diagnosed with cancer also have to navigate a slew of administrative tasks—such as more than one prior authorization—alongside this. Not only do these responsibilities negatively impact their overall experience, but they can also result in worse health outcomes.

Barriers to cancer care: time, homework, and money

The time and money required to go through cancer treatment can deter patients from seeking care or force them to skip important steps in their journey. A recent survey conducted by the nonprofit CancerCare found that 23% of respondents who had or were currently going through cancer treatment and had health insurance said they would postpone or skip doctor appointments to cut costs. Meanwhile, 23% said they delayed or skipped follow-up testing, 19% said they postponed or skipped blood work, 19% said they cut pills in half to make the prescription last longer, and 20% said they skipped doses of prescribed medicines in an effort to lower the financial toll of care.

In general, the study found that patients with required administrative tasks (e.g., calling their insurance to verify coverage or chasing down a prior authorization for a certain test, procedure, or treatment) were 18% more likely to skip or delay treatment than those who didn’t have to complete the same tasks—and pushing off or avoiding treatment was 32% more likely with each additional task a patient had to do.

Employers, too, lose out when administrative work interferes with employees’ productivity and their ability to concentrate on their work. Researchers in 2020 estimated that employees spend $21.57 billion worth of time dealing with health insurance administration, with 53% of that time spent while they’re at work.

The typical cancer care journey

To understand why administrative tasks can so easily turn off a patient from receiving care that can save or prolong their life, it’s important to break down the complex cancer journey.

Prediagnosis
Typically, a patient goes to the doctor for their routine annual appointment or to address a set of symptoms or concerns. Based on their qualifications (e.g., age, sex) and/or their specific concerns, the doctor may recommend a cancer screening. If those results come back abnormal, the provider will then refer the patient to additional testing, such as a diagnostic mammogram, lab tests, or a biopsy. It’s during this stage that an official cancer diagnosis will be made.

Diagnosis
Once the patient receives an official diagnosis, they will then decide on their course of treatment with the help of their oncologist and any other specialist who may be involved. This might include more tests to determine the clinical stage of their cancer and thus the type, intensity, and duration of treatment required, as well as the patient seeking a second opinion to confirm the diagnosis and validate the recommended treatment plan.

Treatment
Next, a patient will begin their cancer treatment as outlined by their care team. They may undergo surgery, chemotherapy, radiation, immunotherapy, hormone therapy, or a combination of all or several. Depending on the clinical stage and cancer type, the goal could be to fully rid the patient of cancer or, for situations in which a cure may not be possible, to focus on treating symptoms or slowing the cancer’s progress so the patient can continue on with comfort and ease. Ongoing testing is common to monitor the progress of treatment, and treatment may be altered or adjusted in response to these results.

Survivorship
When a patient has little to no signs of cancer in their body, they are considered in remission. A doctor may then reduce treatment or remove it altogether while continuing to monitor the patient and their symptoms for years afterward—known as cancer survivorship. This involves ongoing surveillance, consults, and often a lot of coordination between oncologists and primary cancer physicians.

End-of-life care
Unfortunately, there are some patients whose cancer is not curable. The hope is that these patients have goal-setting conversations with their care team as early as possible such that the focus is on keeping the patient and family as comfortable as possible.

The prior authorization problem

Every single stage of the cancer journey, as you can imagine, comes with necessary administrative duties. Consider the forms you fill out just to visit your general practitioner about your history and symptoms, or the contracts you have to read and sign each time you get lab work. Think of the bills you receive at the front desk or in the mail, and the claims you submit and negotiate with insurance.

Because of the severity and seriousness of cancer, it’s inevitable that the journey will include as much paperwork as it does physical and emotional toil. Each additional test to confirm a cancer diagnosis can’t be done without signing on a dotted line. A second opinion or working with a new or different provider requires pulling medical records and getting prior authorization, where the insurer has to approve the service and agree to pay for it before the clinician will provide it (unless the patient is okay with paying completely out of pocket).

With administrative hurdles come negative patient outcomes, not to mention a blow to the person’s mental health.

One 2023 report found that 73% of patients experience a delay of two or more weeks in the prior authorization process, with 20% spending 11 or more hours dealing with issues related to it. Because of the cumbersome process, 22% of patients do not receive the recommended care, and 10% have to pay out of pocket when prior authorization fails.

Physicians, similarly, see the impact of prior authorization issues on patient care. In a 2024 survey by the American Medical Association of 1,000 practicing physicians…

• 78% of doctors reported that prior authorization frequently or sometimes resulted in their patients abandoning a recommended course of treatment
• 19% said that prior authorization hurdles resulted in a serious adverse event where a patient was hospitalized
• 7% said they led to the patient experiencing permanent bodily damage or death

Doctors, too, are burdened by prior authorization and other admin, so much so that it can influence how they do their jobs. AMA reports that 95% of physicians have experienced burnout as a result of the prior authorization process. All these downsides combined, AMA found, have led to 18% of patients trusting their cancer team less and 83% trusting the healthcare system less.

It’s no wonder a large nationwide insurer recently put its new prior authorization policy on hold only weeks after announcing it would ​​require physicians and patients to get approval for most gastroenterology procedures (including diagnostic colonoscopies, a crucial cancer screening). The outcry exemplified what individuals and medical providers alike continue to feel about the mountain of paperwork that comes with treatment. And in January, the Biden administration and Centers for Medicare & Medicaid Services released a rule requiring insurers to fulfill urgent requests within 72 hours and non-urgent requests within seven days, in the hopes of relieving some of the burden associated with the prior authorization process.

How Carrum Cancer Care can help

Carrum’s cancer center of excellence (COE) program aims to provide affordable and high-quality cancer care through expert second opinions, the largest value-based cancer treatment network, and white-glove support.

From the very first day they come to Carrum for cancer treatment, patients are paired with an oncology-trained nurse and an ACS LION-trained cancer care navigator who can educate them on the Carrum benefit, refer them to one of Carrum’s best-in-class cancer centers of excellence—including Johns Hopkins, Memorial Sloan Kettering, Dana-Farber, City of Hope, Texas Oncology, and more—navigate information and resources in preparation for successful treatment, and support the member’s entire cancer treatment journey. Patients who get their cancer treatment through Carrum Health pay little to nothing for their cancer care—and they won’t receive any bills for it. That alone removes a big chunk of the administrative burden.

In addition, providers designated a Carrum cancer COE undergo a rigorous (and proprietary) quality evaluation, including ongoing monitoring of their adherence to evidence-based care guidelines. As a result, they are “gold carded” by Carrum, meaning they do not need to go through the traditional, onerous prior authorization process in order to provide care for Carrum members. This results in much fewer care delays and more satisfied providers and patients.

Cancer treatment is hard enough on the body and mind. Patients deserve a seamless cancer care journey—one in which they can focus on getting the best care possible without getting bogged down (or worse, deterred) by mountains of administrative duties.

Learn more about Carrum Cancer Care, which includes coverage for all cancers.

The information contained on this page is for informational purposes only. No material is intended to be a substitute for professional medical advice, diagnosis, or treatment.