Cancer named top unmanaged cost risk by U.S. employers: report
Cancer has become the single greatest unmanaged cost risk facing employers, a finding that should push HR and benefits leaders to reassess whether their oncology oversight matches the scale of the exposure, according to a new report.
Overall, 95% of employers report three or more of their top 10 highest-cost claimants are cancer-related, and 62% place cancer among their top three overall cost drivers, report cancer-care company AccessHope and specialty care platform Lantern.
Despite that, 94% of employers said GLP-1 drugs receive equal or greater executive attention than cancer, and 55% said mental health does, the report found.
Respondents also named cancer as their greatest unmanaged risk over the next three years at a rate of 52%, more than three times any other concern.
AccessHope chief executive Brad Kreick said the imbalance stems from a misunderstanding of cost drivers. "Cancer costs aren't high simply because drugs are expensive, they're high because treatment decisions are often made without the subspecialty precision oncology requires," Kreick said.
Over the past 30 years, the incidence of breast cancer in women aged 20 to 29 has increased by 45.5%. Additionally, women under 50 have almost twice the incidence of cancer compared to men in this age group, according to a previous report from the Canadian Cancer Society (CCS).
Medavie Blue Cross's 2025 drug trends report found cancer accounted for 4.9% of eligible drug spend by therapeutic category in 2025, ranking behind inflammatory conditions (21.1%), diabetes (11.9%) and mental health (6.4%).
Belief outpaces practice
More than 9 in 10 (94%) employers surveyed said early expert intervention from oncology subspecialists improves outcomes and reduces costs, yet only 6% said they use external oncology experts to review high-cost treatment decisions, finds the AccessHope-Lantern survey of 240 U.S. human resources and benefits leaders.
The report cited a case example showing the financial stakes: a patient with Epidermal growth factor receptor (EGFR)-mutated lung cancer whose community oncologist missed the mutation incurred $339,000 in costs over 12 months with a 30% two-year survival rate. With subspecialist review and correct targeted therapy, costs fell to $238,000 and survival rose to 86%.
EGFR mutations are the most common oncogenic drivers in non-small-cell lung cancer (NSCLC), according to a study posted in the National Library of Medicine.
Lantern associate chief medical officer Dr. Stephen Speicher said patients often navigate treatment decisions without adequate support. "If you're asking a patient to consider changing their treatment path or get a second opinion, you need to start from a place of trust and reach them at the right moment," Speicher said.
With a cancer diagnosis, the long-term impact can be difficult for many working-age Canadians. This can include heightened concerns about long-term savings and job prospects, according to a previous report.
Visibility without control
The recent AccessHope-Lantern report found 77% of employers reported full visibility into cancer-related spend, but only 31% said they had reduced catastrophic claim volatility. Even so, 37% reported meaningful blind spots in cancer spend data despite naming it a top cost driver.
The report also found 81% of employers experience at least occasional delays in cancer drug access tied to prior authorization, and 42% said they cannot routinely challenge their pharmacy benefit manager's decisions on high-cost oncology drugs.
One HR leader at a company with more than 10,000 employees – quoted anonymously in the report – described the pressure this puts on plan design. "The biggest challenge is balancing access to the most effective treatments with the high and rapidly rising cost of cancer drugs. Many therapies are very expensive and treatment plans can be complex," the leader said.
The largest employers – those with 10,000 or more employees – reported the strongest convictions about expert cancer care, with 80% strongly agreeing early intervention improves outcomes. But fewer than half currently offer an expert second-opinion benefit, the report found.
Earlier this year, a New Brunswick legislation expanding job-protected leave received Royal Assent.
With this change, “people facing serious illness, such as cancer, can now access this protection in every province, enabling more Canadians to take time away from work for treatment and recovery without fear of losing their job,” according to the Canadian Cancer Society (CCS).
While it's true that cancer can be fatal, it's not always a death sentence—and survival rates for several major cancers in Canada have increased significantly over the past three decades, according to data from Statistics Canada (StatCan).
