Economic Burden of Chronic Conditions Among Survivors of Cancer in the United States

Abstract

Purpose The prevalence of cancer survivorship and chronic health conditions is increasing. Limited information exists on the economic burden of chronic conditions among survivors of cancer. This study examines the prevalence and economic effect of chronic conditions among survivors of cancer. Methods Using the 2008 to 2013 Medical Expenditure Panel Survey, we present nationally representative estimates of the prevalence of chronic conditions (heart disease, high blood pressure, stroke, emphysema, high cholesterol, diabetes, arthritis, and asthma) and multiple chronic conditions (MCCs) and the incremental annual health care use, medical expenditures, and lost productivity for survivors of cancer attributed to individual chronic conditions and MCCs. Incremental use, expenditures, and lost productivity were evaluated with multivariable regression. Results Survivors of cancer were more likely to have chronic conditions and MCCs compared with adults without a history of cancer. The presence of chronic conditions among survivors of cancer was associated with substantially higher annual medical expenditures, especially for heart disease ($4,595; 95% CI, $3,262 to $5,927) and stroke ($3,843; 95% CI, $1,983 to $5,704). The presence of four or more chronic conditions was associated with increased annual expenditures of $10,280 (95% CI, $7,435 to $13,125) per survivor of cancer. Annual lost productivity was higher among survivors of cancer with other chronic conditions, especially stroke ($4,325; 95% CI, $2,687 to $5,964), and arthritis ($3,534; 95% CI, $2,475 to $4,593). Having four or more chronic conditions was associated with increased annual lost productivity of $9,099 (95% CI, $7,224 to $10,973) per survivor of cancer. The economic impact of chronic conditions was similar among survivors of cancer and individuals without a history of cancer. Conclusion These results highlight the importance of ensuring access to lifelong personalized screening, surveillance, and chronic disease management to help manage chronic conditions, reduce disruptions in employment, and reduce medical expenditures among survivors of cancer.

Costs of cancer along the care continuum: What we can expect based on recent literature

“…With coinsurance rates ranging from 20% to 40%, and with some treatment costs rising above $100,000, OOP costs may become even more overwhelming, even potentially prohibitive, for many survivors. Several other factors put survivors at risk of high costs in addition to age and stage, including oral treatment, 66,67 use of supportive care (such as growth factors and antiemetics 68,69 ), survivors' overall health and comorbidities, 30,31,70,71 and the type of insurance coverage and benefit design. 31,33 Therefore, cancer-specific, stage-specific, and risk factor-specific cost estimates may be needed if data are to be optimally useful for clinicians and patients.…”

Polypharmacy and patterns of prescription medication use among cancer survivors

“…Nearly one‐half of cancer survivors have lived 10 years beyond their diagnosis, and two‐thirds have lived beyond 5 years . Survivors have complex health needs . Nearly 70% of individuals living with cancer have other chronic conditions (eg, diabetes, cardiovascular disease), which may be exacerbated by cancer‐related toxicities.…”

Association between treatment of superficial bladder cancer and 10‐year mortality in older adults with multiple chronic conditions

“…A large majority of older adults with cancer have multiple chronic conditions (MCC), which we define as the presence of ≥2 chronic conditions lasting at least 1 year that require ongoing medical attention and/or limit activities of daily living . Among other things, MCC in patients with cancer strongly affect treatment decision making, health care use, and quality of life . Despite the rising prevalence of cancer among older adults, to the best of our knowledge, the majority of treatment and mortality data and clinical practice guidelines are derived from clinical trials that exclude medically complex older adults .…”

“…[3][4][5][6][7] Among other things, MCC in patients with cancer strongly affect treatment decision making, health care use, and quality of life. [8][9][10][11][12] Despite the rising prevalence of cancer among older adults, to the best of our knowledge, the majority of treatment and mortality data and clinical practice guidelines are derived from clinical trials that exclude medically complex older adults. 13 This has resulted in a lack of information with which to guide decision making for treatment when older patients with cancer and physicians seek to balance quality of life against survival within the context of MCC.…”