The Hidden Cost of Cancer: Time Toxicities and Insurance Delays

Dr. Alexandra Zaleta discusses how most cancer patients face prior authorization delays, despite 95% being approved, highlighting the need for reform.

Many individuals receiving therapy to treat their cancer faced insurance red tape and administrative inefficiencies, resulting in time toxicities, emotional and financial strain, as well as inequities in access to care, according to research entitled ‘The Insurance Maze: How Cancer Patients Get Lost in the Red Tape of Utilization Management’, which was published in the 2025 Red Tape Report by CancerCare.

A set of insurance practices called, referred to as utilization management, is used to control costs by managing when, how and whether certain treatments are approved, and this study underscores the need to reform these practices. Prior authorization and coverage disruptions routinely interfere with patient care, taking time away from treatment and directing it towards the insurance processes. According to the research, has led to advocacy for a more meaningful, and patient-centered, approach.

This research was based on a national survey of 1,201 patients who had been treated for their cancer, and examined the effects of coverage changes and prior authorizations on timely access to care, revealing the real-world consequences of utilization management.

"For me, it's this contradiction: almost everyone is put through the process, and in the end, their initial doctor-prescribed care is approved. But in the meantime, they face significant care delays, time burdens, and impacts on their quality of life," Dr. Alexandra Zaleta, study author and principal investigator of the CARE Study, said in an interview with CURE. “This affects their stress levels, their finances, and their trust in the healthcare system.”

To delve deeper into this topic, Zaleta sat down for an interview with CURE to highlight survey findings, as well as explains what these delays in care indicate about the current system.

Zaleta, strategic leader and scientist, is the associate vice president of Research and Insights at CancerCare where she functions as an in-house expert on understanding challenges faced by people affected by cancer.

CURE: To begin, from your perspective, what was the most striking or concerning statistic that emerged from the survey you recently conducted and published?

Zaleta: For me, the contradiction lies in these findings: almost everyone was put through prior authorization. This was a survey of individuals treated for cancer in the year before taking the survey. Eighty-five percent reported undergoing prior authorization at some point, and 76% in the last year alone. Yet, 95% of these prior authorizations were ultimately approved. The majority of these authorizations are approved, but only after a lot of people faced diagnostic and treatment delays, and tremendous burdens on their time and quality of life.

Therefore, for me, the real pain point is that almost everyone is put through this process, and the majority of the time, after appeals and everything else, their care is eventually approved. However, this approval comes only after 29% experienced delayed diagnoses, 40% had their treatment delayed, and half had to [personally] get involved in fighting the red tape. Many of these individuals lost one or more days of their lives battling a single prior authorization incident. A lot of these folks aren't just going through it once; they're facing prior authorization two, three, four, or even five times in the last year alone. Each time, they potentially have to roll up their sleeves and spend a day or multiple days, with some even reporting they had to spend a whole week or more fighting red tape. This time could have been spent focusing on their recovery and healing, which should be the top priority, or on their family and loved ones, or on other things they care about like work, other roles, or social obligations.

For me, it's this contradiction: almost everyone is put through the process, and in the end, their initial doctor-prescribed care is approved. But in the meantime, they face significant care delays, time burdens, and impacts on their quality of life. This affects their stress levels, their finances, and their trust in the healthcare system.

How would you describe prior authorization and related insurance barriers to someone who has just received a cancer diagnosis?

At its simplest level, we all know that healthcare in the U.S. is really expensive. So, at its simplest level, this is a cost-control measure implemented by insurers and other players in the space. Its stated goal is to check that the treatment a doctor prescribes is medically necessary and appropriate for the condition. That's the insurance industry's framing: to help control costs and, theoretically, ensure people receive appropriate, quality care.

However, our current pain point is that the system is being applied in a way that's widespread and inefficient, creating patient harm and potentially not even generating cost savings for people with cancer. So, while its intended purpose is to increase efficiency and help control costs, what we often see in the real world is the opposite for people living with cancer: they face inefficiencies, delays, and potentially even increased costs by the time the entire process is complete.

What does this indicate about the current system? Do you view this as evidence of unnecessary delays rather than effective cost oversight — and how do you interpret that figure?

From our perspective, it's a problem. While we understand the intended purpose of something like prior authorization, when 85% of individuals are put through this process — three-quarters in the last year alone — and 90% of those are approved out the gate, it still takes many people days or even weeks to get that first answer. The remaining individuals then have to fight for approval, extending the wait to reach that 95% approval rate by even more days, weeks, and in some cases, months, all to ultimately have their doctor-prescribed care approved.

To us, it just doesn't make sense; there's clearly a serious inefficiency in this system where the default is to put people through the prior authorization process, only to arrive at that determination. The process itself may not be very clear or transparent, so people are left trying to figure out how to navigate it. They might be calling their doctor's office for understanding, while the doctor is simultaneously working behind the scenes and also trying to support the patient and their loved ones by answering questions and easing anxieties. This is a genuinely scary and stressful process, especially since many people are caught off guard. While some are aware this might happen, either because it has before or their doctor informed them, many are not. And that, I believe, is a significant pain point. It catches people off guard.

Again, from our perspective, if 95% of these cases in the cancer context are being approved, but only after causing care delays, time burdens, and a worse quality of life, that, to me, is a system that needs reform. It simply doesn't make sense that this is the default experience for people living with cancer.

Reference:

“The Health Insurance Maze: How Cancer Patients Get Lost in the Red Tape of Utilization Management” by CancerCare. 2025 Red Tape Report by CancerCare.

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