Medical Financial Hardship among Cancer Survivors in the United States: What Do We Know? What Do We Need to Know?

Yabroff, K. Robin; Zhao, Jingxuan; Zheng, Zhiyuan; Rai, Ashish; Han, Xuesong

doi:10.1158/1055-9965.epi-18-0617

Cited by 73 publications

(79 citation statements)

References 85 publications

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“…Findings add to the growing literature highlighting financial hardship among cancer survivors and loss of productivity among survivors with MPC . Here, we found an association between distress and financial hardship; we hypothesize that higher distress may be impairing productivity, leading to greater financial hardship.…”

Section: Discussionsupporting

confidence: 61%

Psychobehavioral risk factors for financial hardship and poor functional outcomes in survivors of multiple primary cancers

et al. 2019

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Objective Survivors of multiple primary cancers (MPC) are at increased risk for poor health outcomes compared with survivors of single cancers. Using an adapted psychobehavioral stress‐response model, the study purpose was to identify pathways and individual risk factors associated with poor health outcomes in adults with MPC. Methods Adult MPC survivors (N = 211) with first cancers (stages I‐III) diagnosed within 1 to 10 years were recruited via tumor registry. Employing a cross‐sectional design, established questionnaires were used to operationalize patient characteristics and theoretical constructs including perceived stress, psychological and behavioral responses, financial hardship, social role function, and physical health. Disease and treatment data were obtained via registry and medical records. Structural equation modeling (SEM) was performed to fit, test, and modify the hypothesized psychobehavioral model. Results Following measurement model refinement, an SEM linking self‐management behaviors, distress, financial hardship, and functional health demonstrated a good fit: χ2 (200, N = 206) = 332.06, P < .01; Tucker‐Lewis index (TLI) = .95, comparative fit index (CFI) = .96, standardized root mean residual (SRMR) = .06, root‐mean‐square error of approximation (RMSEA) = .06. Less use of self‐management behaviors predicted higher distress which, in turn, predicted higher financial hardship; higher distress and financial hardship predicted poorer functional health. Several sociodemographic and personal factors predicted self‐management behaviors and distress. Conclusions The hypothesized stress‐response model was partially supported. Data supported pathways among self‐management behaviors, distress, financial hardship, and functional health. Self‐management and distress may represent modifiable intervention targets for MPC survivors. High body mass index (BMI), less education, greater neuroticism, and lower social support were associated with less use of self‐management behaviors and higher distress and should be further evaluated as potential markers of vulnerability.

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Section: Discussionsupporting

confidence: 61%

Psychobehavioral risk factors for financial hardship and poor functional outcomes in survivors of multiple primary cancers

et al. 2019

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“…Medical financial hardship is associated with adverse health outcomes for cancer survivors, including poorer quality of life and worse survival . The medically underserved, including racial/ethnic minorities, the poor, and the uninsured, are most likely to experience medical financial hardship associated with cancer care …”

Section: Delivery Of Cancer Control Services In the United Statesmentioning

confidence: 99%

“…60 The medically underserved, including racial/ethnic minorities, the poor, and the uninsured, are most likely to experience medical financial hardship associated with cancer care. 61 The US Health Care System and Models of Care Delivery…”

Section: Health Care Costs Associated With Cancer In the United Statesmentioning

confidence: 99%

Minimizing the burden of cancer in the United States: Goals for a high‐performing health care system

Yabroff

Gansler

Wender

et al. 2019

CA A Cancer J Clinicians

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Between 1991 and 2015, the cancer mortality rate declined dramatically in the United States, reflecting improvements in cancer prevention, screening, treatment, and survivorship care. However, cancer outcomes in the United States vary substantially between populations defined by race/ethnicity, socioeconomic status, health insurance coverage, and geographic area of residence. Many potentially preventable cancer deaths occur in individuals who did not receive effective cancer prevention, screening, treatment, or survivorship care. At the same time, cancer care spending is large and growing, straining national, state, health insurance plans, and family budgets. Indeed, one of the most pressing issues in American medicine is how to ensure that all populations, in every community, derive the benefit from scientific research that has already been completed. Addressing these questions from the perspective of health care delivery is necessary to accelerate the decline in cancer mortality that began in the early 1990s. This article, part of the Cancer Control Blueprint series, describes challenges with the provision of care across the cancer control continuum in the United States. It also identifies goals for a high‐performing health system that could reduce disparities and the burden of cancer by promoting the adoption of healthy lifestyles; access to a regular source of primary care; timely access to evidence‐based care; patient‐centeredness, including effective patient‐provider communication; enhanced coordination and communication between providers, including primary care and specialty care providers; and affordability for patients, payers, and society.

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“…To our knowledge, few studies to date have comprehensively addressed these multiple domains of medical financial hardship in adults with and without a cancer history . In addition, the majority of previous studies did not use standard measures and were limited to select samples of a particular age group, geographic region, or health insurance type, and were not conducted in a nationally representative sample, thereby complicating synthesis of findings across these studies . Identifying material, psychological, and behavioral domains of medical financial hardship in the same sample will illuminate the scope and intensity of hardship.…”

Section: Introductionmentioning

confidence: 99%

“…4,19 In addition, the majority of previous studies did not use standard measures and were limited to select samples of a particular age group, geographic region, or health insurance type, and were not conducted in a nationally representative sample, 16,17,23 thereby complicating synthesis of findings across these studies. 24 Identifying material, psychological, and behavioral domains of medical financial hardship in the same sample will illuminate the scope and intensity of hardship. In addition, examining the patterns of medical financial hardship can inform the design and development of interventions to reduce it.…”

Section: Introductionmentioning

confidence: 99%

Medical financial hardship among cancer survivors in the United States

Zheng

Jemal

Han

et al. 2019

Cancer

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Background The current study examined medical financial hardship in cancer survivors and those without a cancer history in the United States. Methods The 2013 to 2016 National Health Interview Survey was used to identify cancer survivors (stratified by ages 18‐49 years [1424 survivors], ages 50‐64 years [2916 survivors], and ages ≥65 years [6014 survivors]) and individuals without a cancer history (ages 18‐64 years [66,951 individuals], ages 50‐64 years [31,741 individuals], and ages ≥65 years [25,744 individuals]). Medical financial hardship was categorized into 3 domains: 1) material (eg, problems paying medical bills); 2) psychological (eg, worrying about paying medical bills); and 3) behavioral (eg, delaying/forgoing care due to cost). Generalized ordinal logistic regressions were used to examine the associations between cancer history, hardship, and health insurance deductibles/health savings accounts (among privately insured cancer survivors aged 18‐64 years only). Results Compared with those without a cancer history, cancer survivors were more likely to report any material (ages 18‐49 years: 43.4% vs 30.1%; ages 50‐64 years: 32.8% vs 27.8%; and ages ≥65 years: 17.3% vs 14.7%), psychological (ages 18‐49 years: 53.5% vs 47.1%), and behavioral (ages 18‐49 years: 30.6% vs 21.8%; and ages 50‐64 years: 27.2% vs 23.4%) measure of financial hardship, and multiple domains of hardship (age groups 18‐49 years and 50‐64 years; all P < .01). Among privately insured survivors, having a high‐deductible health plan without a health savings account was found to be associated with greater hardship compared with having low‐deductible insurance. Conclusions Younger cancer survivors are particularly vulnerable to material, psychological, and behavioral medical financial hardship. Interventions designed to reduce financial hardship should consider multiple domains of hardship as well as insurance benefit design.

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Medical Financial Hardship among Cancer Survivors in the United States: What Do We Know? What Do We Need to Know?

Cited by 73 publications

References 85 publications

Psychobehavioral risk factors for financial hardship and poor functional outcomes in survivors of multiple primary cancers

Psychobehavioral risk factors for financial hardship and poor functional outcomes in survivors of multiple primary cancers

Minimizing the burden of cancer in the United States: Goals for a high‐performing health care system

Medical financial hardship among cancer survivors in the United States

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