Cancer survivors who experience medical financial hardship have a higher risk of dying than survivors who do not experience the same hardship, concludes a study involving a nationally representative sample of more than 25,000 cancer survivors in the US.

“Cancer survivors frequently experience medical financial hardship; however, little research has examined its associations with long-term health consequences,” lead author Robin Yabroff, PhD, scientific vice president, health services research, American Cancer Society (ACS), Atlanta, Georgia, said in a statement.

The study found that cancer survivors (aged 18–64 years) with financial hardship had a 17% higher mortality risk than survivors without financial hardship (hazard ratio [HR], 1.17).

Among older cancer survivors (aged 65–79 years) with financial hardship, the risk of dying was 14% higher than among smilarly aged survivors without such hardship (HR, 1.14).

The study was published online on April 20 in the Journal of the National Cancer Institute.

“Efforts to address financial hardship as part of oncology practice and survivorship are needed,” Yabroff emphasized. Growing evidence suggests that elements of health insurance benefits, including patient cost-sharing, deductibles, copayments, and coinsurance, are all associated with medical financial hardship and that higher patient costs can adversely affect treatment adherence, particularly for oral cancer medications, which are increasingly expensive for patients.

Even for patients with Medicare Part D coverage, there is no cap on patient out-of-pocket spending. Patients who experience medical financial hardship may have to choose between healthcare, housing, or a healthy diet and thus are more likely to develop acute and chronic conditions, increasing their mortality risk, she explained.

The ACS Cancer Action Network (ACS CAN), the advocacy affiliate of the ACS, has long advocated for policies to expand access to affordable, comprehensive healthcare coverage, given the proven link between insurance status and cancer outcomes.

ACS CAN is currently urging Congress to enact several policies to improve affordable access to healthcare coverage, including increasing subsidies to purchase marketplace health coverage, expanding Medicaid in the 12 states that do not yet have it, and capping out-of-pocket prescribed drug costs in Medicare Part D

Study in More Than 25,000 Survivors

The study analyzed data for 14,917 cancer survivors aged 18–64 years and for 10,391 cancer survivors aged 65–79 years who were identified from the 1997–2014 National Health Interview Survey. This dataset and its linked mortality files regarding vital status were followed through December 2015.

“Medical financial hardship was measured as problems affording care or delaying or forgoing any care because of cost in the past 12 months,” Yabroff and colleagues explain.

In the 12 months prior to taking the survey, financial hardship was reported by 29.6% of survivors aged 18–64 years and by 11% of those aged 65–79 years.

In the younger cohort, the patients who reported financial hardship were much less likely to be covered by private health insurance. Only 42% of these patients were covered, compared with 80.7% of those without hardship.

They were also more likely to be uninsured, at 31.2%, vs 4.4% of survivors without financial hardship.

Among the older group, those with financial hardship were less likely to have Medicare and private supplemental coverage, at 42.9%, vs 61.1% of those without hardship. They were also more likely to have only Medicare coverage, at 26.8%, compared with 16.7% of older patients who did not experience financial hardship.

In the younger group, the researchers note that “further adjustment for health insurance coverage reduced the magnitude and statistical significance of the association of financial hardship and mortality among younger cancer survivors.” After these adjustments were made, the HR was 1.09 and was no longer statistically significant.

In contrast, further adjustment for supplemental Medicare coverage in the older age group had little effect on the association of hardship and increased mortality risk (the HR remained at 1.15).

“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,” Yabroff commented.

The authors have disclosed no relevant financial relationships.

J Natl Cancer Inst. Published online April 20, 2022. Full text

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