Cancer Can Lead to Financial Hardship, Study Confirms

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December 23, 2015 by NCI Staff

A new study highlights the importance of discussions between patients and their physicians about the costs of cancer care.

Credit: iStock

In a survey of cancer survivors, many reported having experienced financial difficulties—such as going into debt, filing for bankruptcy, and consistent worry about financial issues—related to their disease and its treatment.

The findings from the study were published November 7 in the Journal of Clinical Oncology.

“We found that cancer survivors, especially the working-age population, commonly experience these types of material and psychological financial hardship,” said lead investigator Robin Yabroff, Ph.D., formerly of NCI’s Division of Cancer Control and Population Sciences (DCCPS) and currently of the Department of Health and Human Services Office of Health Policy.

To conduct the study, Dr. Yabroff and her colleagues analyzed responses to the 2011 Medical Expenditure Panel Survey (MEPS) Experiences with Cancer Survey, from approximately 1,200 adult cancer survivors. The MEPS, a nationally representative survey that conducts in-person interviews with patients on health care use and expenses, is conducted by the Agency for Healthcare Research and Quality. NCI and several other federal agencies provide some funding to conduct this additional survey about issues such as the financial burden of cancer and access to medical care among cancer survivors.  

Overall, the researchers found, approximately 20 percent of cancer survivors reported material financial hardship, including having to borrow money or being forced into debt and not being able to pay their medical costs.

Financial hardship was more common among those ages 18 to 64 years than among those 65 and older. In addition, women, racial/ethnic minorities, and those who had most recently received treatment reported higher levels of material financial hardship.

Respondents who had to take an extended leave from their jobs or who switched to a part-time job after receiving their diagnosis were more than twice as likely to report financial hardship as those who remained employed or who were not employed at the time of their diagnosis.

More than twice as many survivors between ages 18 and 64 reported psychological financial hardship than those over the age of 65. Worry about financial matters was most common among the uninsured, with nearly half experiencing this concern.

The researchers noted several limitations to the study, including its small study population and that population-based household surveys like MEPS have a somewhat selected population, including many survivors who are participating long after their initial diagnosis while only containing small numbers of people recently diagnosed with cancer or with rare cancers.

“Ongoing increases in the cost of cancer treatment, specifically oral therapies, highlight the need to identify characteristics of cancer survivors who are more likely to experience financial hardship,” said Dr. Yabroff.

This is a particularly important issue, she continued, because a number of studies have suggested that patients who experience financial hardship or have higher out-of-pocket costs “are more likely to delay or forgo medical care and have poorer adherence to cancer treatment.”

A key component of informed decision-making for patients undergoing cancer treatment is discussions with their physicians about the costs of care, Dr. Yabroff said. But, she continued, clinicians continue to be reluctant to talk with patients about financial issues.

“Thus, efforts to improve detailed physician-patient communication about cancer care cost and affordability will be important, especially with changes in health care access,” Dr. Yabroff concluded.

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