Financial Hardship Associated With Cancer in the United States: Findings From a Population-Based Sample of Adult Cancer Survivors

Abstract

Purpose To estimate the prevalence of financial hardship associated with cancer in the United States and identify characteristics of cancer survivors associated with financial hardship. Methods We identified 1,202 adult cancer survivors diagnosed or treated at ≥ 18 years of age from the 2011 Medical Expenditure Panel Survey Experiences With Cancer questionnaire. Material financial hardship was measured by ever (1) borrowing money or going into debt, (2) filing for bankruptcy, (3) being unable to cover one’s share of medical care costs, or (4) making other financial sacrifices because of cancer, its treatment, and lasting effects of treatment. Psychological financial hardship was measured as ever worrying about paying large medical bills. We examined factors associated with any material or psychological financial hardship using separate multivariable logistic regression models stratified by age group (18 to 64 and ≥ 65 years). Results Material financial hardship was more common in cancer survivors age 18 to 64 years than in those ≥ 65 years of age (28.4% v 13.8%; P < .001), as was psychological financial hardship (31.9% v 14.7%, P < .001). In adjusted analyses, cancer survivors age 18 to 64 years who were younger, female, nonwhite, and treated more recently and who had changed employment because of cancer were significantly more likely to report any material financial hardship. Cancer survivors who were uninsured, had lower family income, and were treated more recently were more likely to report psychological financial hardship. Among cancer survivors ≥ 65 years of age, those who were younger were more likely to report any financial hardship. Conclusion Cancer survivors, especially the working-age population, commonly experience material and psychological financial hardship.

The Relationship Between Cancer Survivors’ Socioeconomic Status and Reports of Follow-up Care Discussions with Providers

“…Cancer survivors are at increased risk for unemployment, debt, and income strains post-treatment even if they are insured [19, 22, 23] and as our results and others have demonstrated, there are many socioeconomically disadvantaged survivors who might benefit from follow-up care discussions. As such, we need to ensure that the growing number of socioeconomically disadvantaged survivors and those experiencing financial hardship have access to follow-up care, which may be promoted by regular discussions about follow-up care between survivors and providers.…”

The impact of chronic conditions on the economic burden of cancer survivorship: a systematic review

“…Our findings are salient for adult cancer survivors with greater number of comorbidities, whom tend to incur excess financial burden throughout survivorship and will likely continue to experience greater burden as the cost of cancer therapies increase [11,36]. Along with rising health-care costs [37], the affordability of care is also a major concern as the onus of medical costs have gradually shifted toward the patient with increasing deductibles, copayments, and use of coinsurance [11,36].…”

“…Cancer survivors continue to have unique medical and psychosocial health-care needs related to their cancer diagnosis that impact health-care costs long after diagnosis [11]. Prior studies have demonstrated that cancer survivors incur, on average, $3000–4000 (US $2011 dollars) in added medical costs compared to individuals without a cancer history [13].…”

“…Additionally, survivors have been shown to have more health concerns posttreatment than age- and sex-matched controls [14], and are also more likely to have hospitalizations, emergency room visits, ambulatory surgeries, and office visits than individuals without a cancer history [15,16]. Cancer survivors also face varying degrees of challenges with coexisting conditions, unmet psychological needs, and financial hardship throughout survivorship [11,17]. In light of recent transformations in the health-care system [18,19] and as more people survive to older ages with MCCs, it is critical to examine the excess burden that chronic conditions impose on survivors’ medical-care costs as well as other aspects of economic burden, including productivity losses due to employment disability, missed work days, and inability to participate in usual activities.…”

Toward Value in Health Care

“…Low-value or unaffordable care from the perspective of the patient can lead to delays in, or discontinuation of, guideline-recommended treatments, medical bankruptcy, and even higher mortality [9][10][11].…”