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Financial Concerns Influence Care-Seeking Behavior of Childhood Cancer Survivors


High out-of-pocket (OOP) medical costs in survivors of childhood cancer can influence their treatment choices and care-related behavior, and ultimately affect their health outcomes, according to a study published in the Journal of Clinical Oncology.

High out-of-pocket (OOP) medical costs in survivors of childhood cancer can influence their treatment choices and care-related behavior, and ultimately, affect their health outcomes. This was the conclusion of a study that evaluated the prevalence of financial burden in this patient population.

High treatment costs, particularly for diseases that require long-term follow-up or long-term care, can be a financial strain for patients. Research studies have shown that financial burden in adult patients with cancer can prove a negative influence on outcomes, including their quality of life, symptom burden, and survival. In the current study, the authors queried whether survivors of childhood cancer experience a financial burden and whether this is associated with high OOP costs and alterations in the patients’ lifestyle or care-seeking patterns.

For their study, the authors studied an age-stratified sample of childhood cancer survivors (n = 580) and used their siblings as a comparison group (n = 173). The survivor pool, which included patients who had enrolled in the Childhood Cancer Survivor Study—a longitudinal follow-up that compares health outcomes of survivors of childhood cancer with those of siblings—shared their household income, OOP medical costs, and issues related to financial burden. The pool of 580 participants who shared their financial information were more likely to be married, had higher education, and higher household incomes, compared with the original 1101 survivors that the authors had selected for this study.

Compared with their siblings, survey participants were:

  • Male (46.7% v 37.1%; P = .025)
  • Unmarried (35.4% v 24.6%; P = .008)
  • Had severe to life-threatening chronic medical conditions (39.7% v 17.1%; P<.001)
  • Have Medicare (5.8% v 1.1%; P = .011) or Medicaid/state insurance (11.5% v 4.6%; P = .008)

Survivors of childhood cancer were more likely to have OOP medical costs that were 10% or higher of their annual income, compared with 2.9% for the sibling (P < .001). The primary reason for higher OOP spending was hospitalization in the past year (odds ratio [OR], 2.3; 95% CI, 1.1—4.9) and annual household income less than $50,000 (OR, 5.5; 95% CI, 2.4–12.8). Additionally, higher OOP spending had a significant association with:

  • Problems paying medical bills (OR, 8.9; 95% CI, 4.4—18.0)
  • Deferring care for a medical problem (OR, 3.0; 95% CI, 1.6—5.9)
  • Skipping a test, treatment, or follow-up (OR, 2.1; 95% CI, 1.1—4.0)
  • Thoughts of filing for bankruptcy (OR, 6.6; 95% CI, 3.0—14.3)

The survey results found a strong association between survivors with a high OOP medical spend and financial burden, the authors note. More importantly, although survivors were on average at least 30 years on average from their cancer diagnosis, many continued to struggle with OOP medical costs and its associated financial burden.

The authors believe that their study, which identified characteristics of the most financially-vulnerable patients, can be used to proactively target specific patients at high-risk of financial burden.


Nipp RD, Kirchhoff AC, Fair, et al. Financial burden in survivors of childhood cancer: a report from the childhood cancer survivor study [published online August 17, 2017]. J Clin Oncol. 2017:JCO2016717066. doi: 10.1200/JCO.2016.71.7066.

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