Medical financial hardship among cancer survivors in the United States

Abstract

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.

Cancer treatment and survivorship statistics, 2019

“…Cancer survivors are vulnerable to financial hardships that may manifest as material (eg, problems paying medical bills, medical debt, and bankruptcy), psychological (eg, stress or worry about paying medical bills), or behavioral (eg, delaying or forgoing necessary medical care because of cost) aspects. Survivors who are younger, underinsured or uninsured, and/or have lower income are more likely to experience financial hardship, as are long‐term survivors of childhood cancer . For example, in one study, approximately 35% of cancer survivors aged 18 to 49 years reported difficulty in paying medical bills compared with 25% in those without a history of cancer; this gap narrowed substantially in those aged 50 to 64 years (27% vs 23%, respectively) .…”

“…Survivors who are younger, underinsured or uninsured, and/or have lower income are more likely to experience financial hardship, as are long‐term survivors of childhood cancer . For example, in one study, approximately 35% of cancer survivors aged 18 to 49 years reported difficulty in paying medical bills compared with 25% in those without a history of cancer; this gap narrowed substantially in those aged 50 to 64 years (27% vs 23%, respectively) . There is increasing emphasis on improving cancer survivors' overall well‐being and quality of life through the application of cancer rehabilitation; psychosocial interventions; principles of disease self‐management; and the promotion of healthy lifestyles, such as avoiding tobacco, maintaining a healthy body weight, avoiding intense ultraviolet radiation exposure, and being physically active throughout life.…”

Worry About Daily Financial Needs and Food Insecurity Among Cancer Survivors in the United States

“…13 Moreover, cancer survivors may undergo considerable psychological distress due to depleted financial resources. 14,15 However, less is known about the extent to which financial worry and food insecurity are associated with cancer survivorship in the United States.…”

“…Moreover, existing studies have been limited to small sample sizes, select cancer sites, specific geographic regions, or certain medical centers. [25][26][27][28] Our study built on previous findings about medical financial hardship among cancer survivors 14,15,29 and examined multiple measures of financial worry regarding nonmedical needs and food insecurity using nationally representative data. We hypothesized that cancer survivors experience financial worry and food insecurity at higher levels than individuals without a cancer history.…”

“…We hypothesized that cancer survivors experience financial worry and food insecurity at higher levels than individuals without a cancer history. Moreover, because younger age, lower family income, and higher comorbid conditions have all been associated with greater health disparities among cancer survivors, 15,30,31 we also hypothesized that the patterns of financial worry and food insecurity vary by age, family income, number of comorbidities, and additional variables of interest, such as race/ethnicity, time since diagnosis, and major cancer site.…”