When comparing atherosclerotic cardiovascular disease (ASCVD) with cancer, patients with both diseases appeared to have the greatest risk of experiencing financial toxicity.
Patients with atherosclerotic cardiovascular disease (ASCVD) are more likely than patients with cancer to experience financial toxicity (FT), but the likelihood is greatest for patients with both conditions, reports a new study in JACC.CardioOncology.
Financial toxicity is characterized by difficulty paying medical bills, high financial distress, cost-related medication nonadherence, food insecurity, and delayed or foregone care due to cost. Patients with cancer might experience short bursts of high expenditures due to chemotherapy treatment, while patients with ASCVD may experience long-term financial distress from drug costs, procedures, clinician visits, and hospital stays.
The present study aimed to compare the health care economic burden on patients with neither ASCVD nor cancer, ASCVD only, cancer only, and ASCVD and cancer. The researchers gleaned data from the National Health Interview Survey (NHIS) from 2013-2018 and enrolled 141,826 nonelderly (18 to <65 years) adults not protected by public insurance. The population included 6887, 6093, and 971 participants who had self-reported cancer, ASCVD, or both, respectively.
The NHIS questionnaire contained these subsections:
The Sample Adult Core, Household Composition, and Family Core files were supplemented with demographic and socioeconomic characteristics, health status, health care services, and health-related behaviors specific to the US adult population.
Females, especially those coming from a middle- or high-income household and with a higher education level, were more likely to report having cancer. In contrast, those reporting ASCVD, regardless of cancer comorbidity, were evenly distributed by sex, education, and income levels, but had a more unfavorable cardiovascular risk profile. The most reported cancers included nonmelanoma skin, breast, cervix, prostate, and other. Similar trends were seen among patients with both ASCVD and cancer.
Other findings showed:
“Heart disease and cancer are the leading causes of death in the United States, yet most research on financial toxicity has focused on cancer patients. It is important to consider that cancer patients may have short bursts of high expenditures for treatments, while heart disease patients are often incurring a more chronic economic burden,” said senior author Khurram Nasir, MD, MPH, MSc, chief of the Division of Cardiovascular Prevention and Wellness at Houston Methodist DeBakey Heart and Vascular Center, in a statement. “The financial burden created by these diseases manifests as another form of affliction. It does very little good if we can treat the cancer or the heart disease, but the patient can’t afford to eat or pay their mortgage.”
Valero-Elizondo J, Chouairi F, Khera R, et al. Atherosclerotic cardiovascular disease, cancer, and financial toxicity among adults in the United States. J Am Coll Cardiol CardioOnc. 2021;3(2):236-246.