The Cancer Casino - Interplay Between Cancer’s Costs and the Demand for Treatment

Wade Templeman

Whether we like it or not, cancer will enter our lives in some way. One of your loved ones may struggle with it, you may get it yourself, or a friend may pass away. This disease is everywhere, a new hurdle in its research sets us back frequently, and it has just as much of an effect on our wallets as it does our emotions. In 2021, the NIH reported that total ‘economic burden’ for cancer patient care [in 2019] totaled upwards of $21 billion dollars factoring in both out-of-pocket and time-related costs. Not to mention, the cancer research industry has been continuously pumping money into the search for a cure. On a macro level, we are getting teased by something that feels so attainable; on the micro scale, our patients are forced to make the toughest decisions when it comes to affordable care. The tables in Vegas may have earned it the nickname ‘Sin City,’ but the games cancer forces some of us to play can be far more sinister. 

While I admit it may be a little grim to compare the entirety of cancer to a casino, its intimidation is centered around our necessity to gamble on its outcome. Going back to that $21 billion figure from the NIH, it detailed that the highest costs were found in the initial phase of care [12 months after diagnosis]. The tab a patient will accrue at this metaphorical casino depends on--for the lack of a better term--how good of a hand they were dealt. This uncertainty when approaching cancer-related decision making is where a patient’s vulnerability can be capitalized upon. For example, take a stereotypical cancer patient: mid 60s and middle to low income. If their ‘hand’ is bad i.e. a stage 4 or very severe diagnosis, their risk of loss skyrockets. Either they cut their losses, save their family money, and take the massive risk of foregoing treatment; or, they gamble on expensive treatment and keep sitting at the table. I am sure you can see now why the casino analogy has stuck out to me so much. Cancer falls perfectly into the ‘house always wins’ predicament. Either succumb to cancer, or it’ll drain your wallet in the process of beating it. 

The difference between this analogy and an actual casino is that we all have the choice to not walk into a real casino and sit down at a table. Cancer does not give us that choice, and the health system knows that. Just like a real casino, the system benefits off of the desperate and vulnerable. Another NIH study in 2023 found that of 374 major cancer drugs approved by the FDA in the last two decades, their cumulative improvement to patient lifespan could be described as ‘marginal’ at best. Yet, more drugs continue to be approved with limited testing and prices continue to inflate. As depressing as it is to admit, these drugs are products in our capitalist medical system. When patient numbers increase or the severity of cases is high, demand increases; and we all know what happens when demand increases. Just like how gambling is unavoidable in our own capitalist economy, the toll cancer takes on our medical economy is simply a necessary evil as the product of our overall system. 

I would love to be a high roller as much as the next person, but even they lose sometimes when it’s all said and done. Those that can afford the exorbitant cancer treatment will shell out whatever is necessary to get the treatment they need, thus feeding back into the system. The depressing thoughts of those sitting for hours on end at the slot machines spending away their last savings has the same feeling as a chemotherapy clinic now doesn’t it? There will be a time when each of us needs to sit down at this messed up casino for one reason or another, so I’d encourage one to start planning on what to do if dealt a bad hand. 


NIH Studies:


Annual Spending:

Annual Report to the Nation on the Status of Cancer, Part II: Patient Economic Burden Associated With Cancer Care. JNCI 2021 Oct 26. DOI: 10.1093/jnci/djab192.


FDA Approvals:

Michaeli DT, Michaeli JC, Michaeli T. Advances in cancer therapy: clinical benefit of new cancer drugs. Aging (Albany NY). 2023 Jun 19;15(12):5232-5234. doi: 10.18632/aging.204839. Epub 2023 Jun 19. PMID: 37338507; PMCID: PMC10333065.

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