MedicalResearch.com Interview with:
Zhiyuan “Jason” Zheng PhD
Director, Economics and Healthcare Delivery Research
American Cancer Society, Inc.
Atlanta, GA 30303
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Historically, the cost of healthcare can be a substantial burden for cancer survivors and their families in the US. Even with health insurance, a cancer diagnosis can impose significant out-of-pocket costs for medical care. These are partially due to the rising costs of cancer treatments in recent years, moreover, the increasing levels of coinsurance, copayments, and deductibles also shift a significant portion of the burden to cancer patients.
We found that younger cancer survivors, those aged 18-49 years, bear a higher burden than their older counterparts. We also found that two-thirds of cancer survivors enrolled in high-deductible health plans did not have health savings accounts, and they are more vulnerable to financial hardship than those in high-deductible health plans with health savings accounts and those covered by low-deductible plans.
These findings are important to patients because 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.
MedicalResearch.com: What should readers take away from your report?
Response: Our study conceptualized medical financial hardship into material (e.g. problems paying medical bills), psychological (e.g. worrying about paying medical bills), and behavioral (e.g. forgoing/delaying care because of cost) domains. Moreover, this is the first study utilizing nationally representative data to examine hardship intensity, namely co-occurrence of multiple domains. We found that medical financial hardship seems to persist even years after cancer diagnosis. Better understanding of patients’ experiences with financial hardship can inform the development of interventions to reduce its impact in the long-term.
Our study shows that younger cancer survivors, those aged 18-49 years, experience greater financial hardship than their older counterparts, especially in comparison to similar adults without a cancer history. We believe this is probably because younger cancer survivors do not have the opportunity to accumulate financial assets to pay for medical expenses. In addition, a cancer diagnosis might interrupt education or employment, limit the type and amount of work or even the ability to work at all, and consequently reduce their access to employer-sponsored health insurance coverage.
Another issue that we identified in this study is that cancer survivors enrolled in high-deductible health plans without health savings accounts were more likely to experience medical financial hardship than those with health savings accounts. In the United States, more than 40% of employer-based private insurance coverage in 2017 were high deductible plans. Health saving accounts may help mitigate medical financial hardship. Patients can also seek information from financial navigators and clinicians to take advantage of health savings accounts when possible.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: Medical financial hardship might impact cancer survivors and their families in their daily lives, including non-medical financial consequences, for example, whether cancer survivors suffer food insecurity to the extent that they skip meals or cannot afford healthy food. Future research should address other non-medical hardship experienced by cancer survivors. This is because we already knew that extreme financial insolvency, i.e. bankruptcy, increases the risk of early mortality among cancer survivors. 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. Therefore, we also expect that cancer survivors and their families may reduce their non-medical consumption, including leisure activities, food and housing, or investments in education. All these social determinants of health factors could impact health outcomes and longevity for cancer survivors, and should be examined in the future.
MedicalResearch.com: Is there anything else you would like to add?
Response: Our study showed that the most common type of medical financial hardship was the psychological domain, especially among the younger cancer survivors aged 18-49, suggesting that patients and their families should be prepared not only medically but also be ready mentally for the potential of financial hardship. Cancer patients should increase their awareness of the multiple components of financial hardship, and talk to their clinicians about their concerns, if they have any. Furthermore, both patients and oncologists should consider clinical toxicity and financial hardship as potential harms of cancer treatments so that they can work together to improve treatment adherence and health outcomes.
I don’t have any financial disclosure.
Zheng, Z. , Jemal, A. , Han, X. , Guy, G. P., Li, C. , Davidoff, A. J., Banegas, M. P., Ekwueme, D. U. and Yabroff, K. R. (2019), Medical financial hardship among cancer survivors in the United States. Cancer. doi:10.1002/cncr.31913
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