Hawaiʻi cancer patients have been racking up a staggering tab on the mainland. A new analysis from the University of Hawaiʻi Cancer Center finds residents spent more than $230 million on off-island cancer care between 2021 and 2023, a price tag that reflects both the state’s geographic isolation and gaps in highly specialized services at home. The study, based on insurance claims, also arrives just as the center prepares to open a new early phase clinical trials unit in July, a move researchers hope will keep more patients in state.
According to the University of Hawaiʻi at Mānoa, investigators examined de-identified commercial claims filed through the Hawaiʻi Medical Service Association. They found out-of-state cancer care costs reached about $58 million in 2021, jumped to $94 million in 2022 and came in just under $79 million in 2023, for a total of more than $230 million across three years. The work was presented as an electronic abstract at the American Society of Clinical Oncology and focused only on direct medical costs billed to HMSA. It did not include travel expenses such as airfare, lodging or lost wages, all of which can sharply increase what experts refer to as “financial toxicity” for patients and their families.
“Patients who must leave the islands for specialized cancer care bear enormous burdens: on top of medical bills, they may face travel expenses, time away from work, and the emotional challenge of receiving treatment far from home and the support of their loved ones,” said Dr. Hideko Yamauchi, the study’s principal investigator. Yamauchi and co-authors say that charting where patients go and what services they seek elsewhere can help pinpoint where investment in Hawaiʻi would have the biggest impact. The project was led by the UH Cancer Center with collaboration from HMSA, according to the University of Hawaiʻi at Mānoa.
Where the spending went
The analysis found breast cancer accounted for the largest slice of out-of-state spending at roughly $59.5 million. That was followed by leukemia at $46.4 million, lymphoma at $21.5 million, prostate cancer at $14.9 million and pulmonary cancers at $14 million. When researchers looked at what proportion of care for each disease left the islands, leukemia stood out, with about 39 percent of its related spending occurring off-island. Central nervous system tumors and multiple myeloma also had high off-island shares, near 27 percent and 21 percent respectively. Those breakdowns are detailed in the abstract published in the Journal of Clinical Oncology.
Study limits and what it misses
The findings offer only a partial view of the true financial hit. Because the study used HMSA’s commercial claims database, it reflects just one insurer’s members and does not capture costs billed to other health plans. That means the total statewide spending on mainland cancer care is almost certainly higher. On top of that, the analysis left out nonmedical expenses that often decide whether families can even attempt treatment elsewhere. Plane tickets, hotel stays, meals and time away from work did not make it into the spreadsheet, even though those costs are painfully familiar to many caregivers. The Hawaiʻi Medical Service Association provided the claims data used in the study.
Local response and capacity building
Leaders at the UH Cancer Center point to several efforts intended to cut down on those expensive trips. The Hoʻōla Early Phase Clinical Research Center is scheduled to open in July and will offer qualifying patients access to phase I clinical trials without leaving the state. At the same time, the statewide Ka ʻUmeke Lama oncology initiative aims to expand the cancer care workforce and strengthen referral pathways, according to the UH Cancer Center. Center officials say that bringing more high-complexity services to the islands could help patients stay closer to their support networks while still getting cutting-edge care.
National research has increasingly flagged financial toxicity as a major side effect of cancer treatment, and the extra burden of long-distance travel only makes it worse. Strategies like tele-oncology visits, financial navigation services and expanded access to clinical trials near patients’ homes are among the responses experts recommend, as outlined in a review in the Journal of Clinical Oncology.
For patients, clinicians and policymakers in Hawaiʻi, the new numbers simply quantify a long-running concern. Even when care technically exists in state, it can feel out of reach if the right specialist or trial requires days of travel and a stack of extra bills. As Hoʻōla opens its doors and statewide initiatives roll out, researchers say follow-up work will be needed to see whether those investments trim mainland spending and ease the financial strain on families facing cancer.
