The social and economic toll of cancer survivorship: a complex web of financial sacrifice

Abstract

Purpose To assess the financial outcomes and associated social and economic effects on cancer survivors and their families. Methods We assessed the responses of 1656 cancer survivors to a survey with both closed- and open-ended questions about cancer-related financial sacrifices they and their family experienced and evaluated differences in financial sacrifice by reported levels of cancer-related debt. Results The most commonly reported financial sacrifices included cutbacks on household budgets, challenges with health care insurance and costs, career/self-advancement constraints, reduction/depletion of assets, and inability to pay bills. Survivors who incurred $10,000 or more in debt were significantly more likely to report social and economic impacts, including housing concerns and strained relationships. Conclusions Our analysis demonstrates both the frequency with which cancer survivors and families must make financial sacrifices as a result of their cancer, and the variety of forms that this sacrifice can take, even for individuals who have health insurance. The many types of financial hardship create challenges that are unique to each survivor and family. Implications for Cancer Survivors Interventions that allow for personalized assistance with the specific financial and social needs of cancer survivors and their families have the potential to address a critical aspect of the long-term wellbeing of this important population.

The psychosocial cost burden of cancer: A systematic literature review

“…Most studies in this review focused narrowly on a selection of constructs that related to the psychological and social domains of the psychosocial burden of cancer and, in particular, the financial impact of illness. This focus on financial impacts of cancer is likely a result of most research originating from the US where the impoverishing consequences of cancer are well documented 37 . There was a lack of emphasis in studies investigating and capturing sub‐clinical levels of distress that are nevertheless significant and important for understanding the experience of psychosocial burden from patient, family, and caregiver perspectives.…”

The experience of financial stress among emerging adult cancer survivors

“…Cancer-related financial stress often involves making financial sacrifices due to debt, and this debt places limitations and strains on social relationships. 3 Participants with limited financial means had to rely on friends and family to afford the cost of treatment. Because of this, many participants felt like a "financial burden" on their family (HC-115, 27-year old man).…”

“…Cancer survivors incur substantial medical costs, including "out of pocket" costs, lost days of work, need for specialized assistance, and medical debt, potentially leading to bankruptcy. [1][2][3] Compared to those without a history of cancer, cancer survivors are more likely to report financial hardships across material, behavioral, and psychological domains. 4 These financial hardships have been referred to by many terms including financial toxicity, financial burden, financial strain, and financial sacrifice, 2,3,5 and often result in reports of decreased health-related quality of life.…”

“…[1][2][3] Compared to those without a history of cancer, cancer survivors are more likely to report financial hardships across material, behavioral, and psychological domains. 4 These financial hardships have been referred to by many terms including financial toxicity, financial burden, financial strain, and financial sacrifice, 2,3,5 and often result in reports of decreased health-related quality of life. 6 In this study, financial stress is used to encompass these multiple terms and to describe the psychological burden of illness-related expenditures.…”

Disparities in Medical Debt Among U.S. Adults with Serious Psychological Distress

“…14,15 Many of the available studies on medical debts assess care seeking and persistent debts among people who have survived cancer, with the preponderance of evidence suggesting that cancer survivorship is associated with persistent financial hardship and medical debts. [16][17][18] Additional studies have examined the odds of filing for bankruptcy after debilitating spinal cord injuries, 19 the relationship between personal debt and suicidal ideation, 20 and the relationship between medical debt and use of payday loans. 21 These studies suggest that there are deleterious influences of having medical debts, including postponing needed care because of a desire to not have any more bills that cannot be paid.…”