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Financial Hardship, Psychological Distress Hurting Working-Age Cancer Survivors, CDC Says

Allison Inserro
More than a quarter of adults aged 18 to 64 years reported they had trouble paying bills because of cancer, and over one-third reported psychological distress, according to a report from the CDC.
The latest national data about the impact of cancer on personal finances were released Thursday in a report from the CDC, which found that cancer survivors of working age had significantly higher annual out-of-pocket (OOP) medical expenditures than those without a cancer history.

More than a quarter of adults aged 18 to 64 years reported they had trouble paying bills because of cancer, and over one-third reported psychological distress.

The CDC noted that the number of Americans with a history of cancer (currently estimated at almost 17 million) is expected to rise in the coming years, and the economic burden associated with living with a cancer diagnosis will likely rise as well. It said that efforts by providers, practices, and payers to reduce OOP costs—using “evidence-based, sustainable strategies”—could be an important part of high-quality cancer care.

To estimate annual OOP expenditures and financial hardship among cancer survivors and those without a history of cancer, the CDC, the American Cancer Society, and the National Cancer Institute analyzed data from the 2011-2016 Medical Expenditure Panel Survey (MEPS). MEPS self-administered questionnaires—answered by those with a cancer history (n = 4753) and those without (n = 119,018)— included questions about how cancer, its treatment, and lasting effects of treatment affected respondents’ access to care, employment, and financial situation. 

The average annual OOP spending per person was significantly higher among cancer survivors ($1000; 95% CI, $886-$1113) than among persons without a cancer history ($622; 95% CI, $606-$639).

Financial toxicity was reported by 25.3% of cancer survivors, and 34.3% reported psychological hardship, such as from worrying about medical bills.

Financial hardship was more common among the uninsured than among those with insurance coverage. But even those with health insurance went into medical debt or filed for bankruptcy because of cancer, the report noted. For those without insurance, the medical bills took up a larger proportion of household income.

Evidence about the financial toll that cancer takes on survivors has been growing for about a decade, as payers began shifting more financial responsibility to patients in the form of high-deductible health plans, increased co-payments, and other cost-sharing changes. In addition, while new oncology treatments are revolutionary and sometimes curative, they come at a much higher price than previous chemotherapy regimens.

Financial hardship can take the form of not being able to pay other household bills, deferring retirement, or not filling needed medications because of cost.

At a recent cancer conference this year, one Medicaid-insured woman with cancer spoke of not filling prescriptions that would improve her comfort and quality of life, like pain or sleep medications, which she called “luxury items.”

Cancer survivors were more likely to be older, female, non-Hispanic white, married, privately insured, and working full-time, and to have higher education and multiple chronic conditions, than were persons without a cancer history.

About one-half of cancer survivors received their diagnosis at least 5 years before the survey. In unadjusted analysis, cancer survivors had higher mean annual OOP expenditures and were more likely to have high OOP burden than were persons without a cancer history.

The percentage of survivors who reported experiencing material or psychological financial hardship was higher among minority racial/ethnic groups than among whites. It was also highest for persons aged 40 to 49 years.

Survivors who were uninsured were most likely to report material financial hardship (36.5%), followed by those with public (33.1%) and private (21.9%) insurance. Psychological financial hardship was also higher among the uninsured (49.4%) than among those with public (35.9%) or private (32.5%) health insurance coverage.

The report said that survivors suffer from “disproportionate financial hardship” and called for systematic screening for financial hardship at cancer diagnosis and throughout care, integrating discussions about the potential for financial toxicity in shared treatment decision making, and linking patients and survivors to available resources that could help access high-quality evidence-based care.

The CDC said the results have at least 4 limitations. First, the diagnosis of cancer was based on self report and not verified by medical records; second, analyses were not stratified by cancer anatomic site because sample sizes were insufficient, so the report cannot be used to determine whether certain types of cancer lead to more hardship than other types; third, other information is also unavailable, such as stage of cancer at diagnosis and types of treatment received before the survey; and fourth, even though comorbidity was included in multivariable models, some OOP spending might result from higher comorbidity among cancer survivors. But the authors wrote that measures of material and psychological hardship were specific to cancer, its treatment, and lasting effects of treatment.

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