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Medical financial hardship includes problems paying bills and other
challenges with money; psychological stress like intense worry over
unpaid bills; and behavioral issues like delaying needed care
because of cost.
Cancer survivors ages 18 to 49 appeared hardest hit by these
problems. About 43 percent had health-related money problems,
compared to 30 percent of their counterparts who never had cancer,
and 31 percent delayed care due to costs, compared to 21 percent of
average people this age.
"Although cancer patents have benefited from newer and more advanced
treatments, financial hardship may lead to emotional distress, cause
changes in health behaviors, and jeopardize treatment adherence and
health outcomes," said lead study author Zhiyuan "Jason" Zheng of
the American Cancer Society in Atlanta.
Young adults may struggle the most because cancer might interrupt
their education and limit their access to employer-provided health
insurance, Zheng said by email. This can have devastating health
effects and lead patients to also face challenges like food and
housing insecurity, he added.
"We already knew that extreme financial insolvency, i.e. bankruptcy,
increases the risk of early mortality among cancer survivors," Zheng
said. "Although we don't know the exact pathways, it has been
hypothesized that financial hardship can cause high stress among
cancer survivors, force some patients to be non-adherent to
treatments to save money, and lower their overall quality of life."
Newer cancer drugs can cost upwards of $10,000 a month, compared
with an average of $1,000 a month 20 years ago, the study authors
note. Patients are also picking up an ever larger share of the tab
in co-payments, deductibles and other out-of-pocket costs.
As reported in Cancer, the researchers examined data on 4,340 adult
cancer survivors under 65 plus 98,692 people the same age who never
had cancer. They also looked at 6,014 survivors age 65 and older,
plus 25,744 older adults without cancer.
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Most of the survivors had been diagnosed at least a decade earlier.
About two-thirds of them had insurance through employers or another
type of private health coverage.
The study wasn't a controlled experiment designed to prove whether
or how cancer survivors' medical costs might directly impact their
health. Researchers also lacked detailed clinical data about
patients' exact diagnoses and treatment histories.
Even so, the results add to mounting evidence suggesting that cancer
survivors experience more money issues related to their diagnosis
than people with other chronic health problems, said Dr. Ryan Nipp,
a researcher at Harvard Medical School and Massachusetts General
Hospital in Boston who wasn't involved in the study.
"Patients and families should openly discuss any and all concerns,
particularly financial concerns, early and often with the clinicians
caring for them," Nipp said by email. "Clinicians can refer patients
to social workers, financial counselors, or patient navigators,
depending on their availability, to try to help."
This is especially important for younger individuals, said Dr. Alana
Biggers of the University of Illinois at Chicago, who wasn't
involved in the study.
"Young cancer survivors have to deal with the financial difficulties
associated with being a Gen Xers or millennials in addition to the
financial burden of healthcare costs," Biggers said by email. "Gen
Xers and millennials are burdened with student loan debt and credit
card debt; many are starting families and may have their first
mortgage; additionally, younger people may have opted to have an
insurance plan with a lower premium and a high deductible or
co-payments."
SOURCE: http://bit.ly/2sBt05X Cancer, online January 21, 2019.
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