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 Researchers examined data on 580 adults who had been diagnosed with
cancer an average of three decades earlier, while they were
children, and 173 of their adult siblings.
Overall, one in 10 childhood cancer survivors had high out-of-pocket
health costs, spending at least 10% of their income on care, the
study found. By contrast, roughly 3% of their siblings had medical
costs that high.
“Many survivors of childhood cancer develop chronic health
conditions, often related to the cancer or its treatment, resulting
in a need for long-term medical care, which can place them at risk
for experiencing financial distress related to high health care
costs and time away from work,” said lead author Dr. Ryan Nipp of
Massachusetts General Hospital and Harvard Medical School in Boston.
“Specifically, those with higher out-of-pocket costs were more
likely to be unemployed, hospitalized in the past year, have more
severe chronic medical conditions and lower incomes,” Nipp said by
email.
Advances in cancer treatment in recent years have helped a growing
number of young patients survive the diagnosis, often transforming
their illness from a death sentence to a lifelong chronic disease.
But better survival odds also mean these children may have an
elevated risk of health problems like heart disease, kidney
impairment and new types of cancer in adulthood, researchers note in
the Journal of Clinical Oncology, online August 17.
Over time, many healthcare plans have also increased cost-sharing
with higher deductibles, co-payments or co-insurance, all of which
can place a financial strain on cancer survivors.
To assess this financial impact, researchers surveyed a random
sample of childhood cancer survivors and their siblings in 2011 and
2012. The survivors were part of the Childhood Cancer Survivor
Study, which enrolled adults who had been treated for childhood
cancers between 1970 and 1986.
Survivors who had been hospitalized in the past year were more than
twice as likely to have high out-of-pocket costs, the study found.
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When survivors had household income of less than $50,000 a year,
they had more than five times the odds of facing high out-of-pocket
costs.
Steep out-of-pocket costs also meant survivors were much more likely
to struggle with paying their medical bills, defer care for a health
problem, skip a test or treatment, or consider filing for
bankruptcy.
One limitation of the study is that it was conducted before full
implementation of the Affordable Care Act, the researchers note. As
a result, the findings don’t offer any insight into how the ACA may
have influenced out-of-pocket costs for cancer survivors.
“In an ever-changing landscape of insurance markets and coverage,
patients and families should try to stay as informed as possible
about their current health insurance coverage and use their
resources in terms of social workers or hospital financial
counselors to help choose plans that will provide the most adequate
coverage for their needs,” advised Dr. Dava Szalda of the Children's
Hospital of Philadelphia and Penn Medicine’s Abramson Cancer Center
Survivorship Program.
“Survivors of childhood cancer, at a minimum, require lifelong
annual follow-up visits with attention to their cancer-related
history,” Szalda, who wasn’t involved in the study, said by email.
“Screening for long-term effects, while ideally preventing future
morbidity and mortality, comes at a cost.”
SOURCE: http://bit.ly/2xPZREE
J Clin Oncol 2017.
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