Medical Financial Hardship Drives Mortality Risk for Cancer Survivors

Cancer survivors struggling with medical financial hardship face a higher mortality risk than cancer survivors who do not face the same financial strain, according to a national study published in the Journal of the National Cancer Institute (JNCI).

Patient financial responsibility has long been recognized as an issue for cancer survivors and is a fundamental impediment to care access. According to a report from the Centers for Disease Control and Prevention (CDC), 25 percent of all survivors experience financial burden even after entering remission.

“Cancer survivors frequently experience medical financial hardship, however, little research has examined its associations with long-term health consequences,” Robin Yabroff, scientific vice president, health services research at the American Cancer Society and lead author of the JNCI study, said in a public statement. “Our findings show the need to address financial hardship to ensure that cancer survivors do not delay or forgo necessary care because they cannot afford it.”

The study, led by researchers at the American Cancer Society (ACS), used data from the National Health Interview Survey (NHIS) to identify 25,000 cancer survivors.

Nearly 30 percent of cancer survivors between 18 and 64 years old reported financial hardship in the past 12 months. In the study, medical financial hardship was defined as problems paying healthcare costs, financial distress, and missing out on care due to high costs.

Cancer survivors older than 65 years were less likely to report financial hardship but were more likely to have health insurance coverage through Medicare because of age eligibility.

Regardless of age, cancer survivors in both groups had a higher risk of mortality if they were facing financial hardship. However, comprehensive health insurance coverage mitigated hardship and mortality risk for survivors younger than 65 years.

“Our findings underscore the protective effects of Medicare coverage and highlight the importance of comprehensive health insurance coverage in mitigating financial hardship for cancer survivors under 65,” said Yabroff. “Efforts to address financial hardship as part of oncology practice and survivorship care are needed.”

Given the link between insurance status and cancer outcomes, the American Cancer Society Cancer Action Network (ACS CAN), the advocacy affiliate of the ACS, has called for policy changes that expand access to affordable health coverage, including Medicaid expansion.

Research shows that expanding Medicaid coverage for cancer patients could help reduce the poor health outcomes associated with financial burden.

For example, after the Affordable Care Act (ACA) was implemented in 2014, cancer survivors between 18 and 64 had fewer concerns regarding patient financial responsibility, care access, and medication affordability.

Estimates reveal that younger cancer survivors may face the fewest patient financial responsibility issues in the past 20 years, thanks to the ACA.

Yet, further work must be done to mitigate the impact of cancer costs on survivors. In addition to policy changes, experts suggest provider communications about out-of-pocket costs and screening for financial hardship to close some of the care gaps.