Financial hardship in adult survivors of childhood cancer: A report from the Childhood Cancer Survivor Study (CCSS).

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 10026-10026
Author(s):  
Paul C. Nathan ◽  
I-Chan Huang ◽  
Yan Chen ◽  
Tara O. Henderson ◽  
Elyse R. Park ◽  
...  
Keyword(s):  
Medical Care ◽  
Childhood Cancer ◽  
Elevated Risk ◽  
Financial Hardship ◽  
Factor Scores ◽  
Material Hardship ◽  
Financial Outcomes ◽  
Adolescent Cancer ◽  
Cranial Radiation ◽  
Medical Bills

10026 Background: The impact of childhood and adolescent cancer on the long-term financial outcomes of survivors is poorly understood. We compared financial hardship between survivors and siblings enrolled in the CCSS and identified survivors at elevated risk. Methods: Survivors treated for cancer at age < 21 years in 1970-1999 and siblings responded to a survey (23 binary-response questions) at age ≥26 years administered in 2017-2019. Principal component analysis with promax rotation extracted 3 factors with eigenvalues > 1 and KR-20 reliability coefficients > 0.7, retaining items with factor loadings > 0.4. These factors were behavioral hardship (8 items, e.g., forgone needed medical care), material hardship/financial sacrifices (8 items, e.g., problems paying medical bills) and psychological hardship (3 items, e.g., worry about having enough money to pay rent/mortgage). Factor scores were calculated by adding the item responses and dividing by their standard deviation. Multiple linear regression examined the association of sociodemographic and cancer treatment variables with factor scores. Results: Among 3349 survivors (49% male; median age [range] 40.2 [26.0-67.4] years) and 976 siblings (42% male, median age 46.5 [ 26.1-69.2] years), survivors were more likely to report being sent to debt collection (29.5 vs 21.4%), problems paying medical bills (20.0 vs 11.9%), foregoing needed medical care (13.3 vs 7.7%) and worry/stress about paying their mortgage (32.8 vs 23.2%) or having enough money to buy nutritious meals (25.0 vs 16.2%), all P < 0.001. Survivors reported greater hardship than siblings on all 3 factors: behavioral hardship (standardized mean score 0.51 vs 0.36), material hardship/financial sacrifices (0.63 vs 0.44), psychological hardship (0.69 vs 0.44), all P < 0.001. Behavioral hardship was increased by female gender (regression coefficient [ꞵ] 0.17, 95% CI 0.10-0.25), < high school (ꞵ 0.45, CI 0.12-0.79) or < college (ꞵ 0.18, CI 0.09-0.26) education, no (ꞵ 1.14, CI 0.93-1.35) or public (ꞵ 0.23, CI 0.10-0.35) health insurance, being divorced/separated (ꞵ 0.28, CI 0.10-0.46) and ≥250mg/m2 anthracycline chemotherapy (ꞵ 0.09, CI 0.00-0.19). The same variables were significantly associated with the other two hardship factors, but total body irradiation and cranial radiation also contributed to the risk of material hardship/financial sacrifices, and ≥8g/m2 cyclophosphamide equivalent dose and cranial radiation contributed to psychological hardship. Conclusions: Survivors of childhood and adolescent cancer are at elevated risk for financial hardship as compared to sibling controls. Those at highest risk can be defined using a combination of sociodemographic and treatment variables. This information can be used to inform targeted intervention strategies to reduce the risk of poor financial outcomes in this vulnerable population.

The impact of ACA on medical financial hardship among cancer survivors.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e18160-e18160
Author(s):  
Aaron N Winn ◽  
Parker Knueppel ◽  
Joan Marie Neuner
Keyword(s):  
Cancer Survivors ◽  
Medical Care ◽  
Family Members ◽  
Financial Hardship ◽  
P Value ◽  
Difference In Difference ◽  
Significant Difference ◽  
Medical Bills ◽  
The Impact ◽  
Privately Insured

e18160 Background: Prior research has documented that privately insured cancer patients are exposed to significant financial burdens which can result in bankruptcy. A key provision of the Affordable Care Act (ACA) was to set limits on patients out-of-pocket (OOP) spending, which was implemented in 2014. This study aims to assess if OOP limits reduces financial hardship. Methods: Using the 2000-2017 National Health Interview Survey we identified cancer survivors under age 65. We performed a difference in difference analysis which compared financial hardship for low- or moderate-income individuals (LMII), family income under $50,000, to those with higher incomes before and after OOP limits were implemented for privately insured patients. Financial hardship was measured in the following ways: delayed medical care due to cost and the number of family members delayed medical care due to costs, could not afford a prescription, medical care or seeing a specialist, and problems paying medical bills. We used multivariate regression models adjusting for age, race, marital status, gender and size of family. All analyses accounted for the complex survey design and weights. Results: We identified 20,879 privately insured, cancer survivors age 65 or younger. The impact of the ACA resulted in lower financial hardships for LMII compared to higher income persons for most outcomes. The impact of the OOP limits on financial hardship for LMII was seen in any family member delaying care due to costs (difference-in-difference (DiD) = -3.6%; 95% CI = -5.9%, -1.5%; p-value = 0.002), number of family members delaying care due to costs (DiD = -0.048; 95% CI = -0.082, -0.135; p-value = 0.002), had problems paying medical bills (DiD = -3.3%; 95% CI = -6.3%, -0.4%; p-value = 0.028), could not afford prescription medication (DiD = -2.3%; 95% CI = -4.2%, -0.3%; p-value = 0.023), could not afford medical care (DiD = -1.9%; 95% CI = -3.5%, -0.3%; p-value = 0.021), but there was no statistically significant difference in the ability to afford seeing a specialist (DiD = -1.1%; 95% CI = -2.6%, -0.5%; p-value = 0.002). Conclusions: Little research has examined the impact of the ACA’s OOP spending limits. In this study we find that after the introduction of OOP spending limits, financial hardship measured in a variety of ways significantly decreased for LMII.

scholarly journals Burden and Consequences of Financial Hardship From Medical Bills Among Nonelderly Adults With Diabetes Mellitus in the United States

2020 ◽  
Vol 13 (2) ◽  
Author(s):  
César Caraballo ◽  
Javier Valero-Elizondo ◽  
Rohan Khera ◽  
Shiwani Mahajan ◽  
Gowtham R. Grandhi ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
United States ◽  
Food Insecurity ◽  
Medical Care ◽  
Financial Distress ◽  
The United States ◽  
Financial Hardship ◽  
Comorbidity Burden ◽  
Patients With Diabetes ◽  
Medical Bills

Background: The trend of increasing total and out-of-pocket expenditure among patients with diabetes mellitus represents a risk of financial hardship for Americans and a threat to medical and nonmedical needs. We aimed to describe the national scope and associated tradeoffs of financial hardship from medical bills among nonelderly individuals with diabetes mellitus. Methods and Results: We used the National Health Interview Survey data from 2013 to 2017, including adults ≤64 years old with a self-reported diagnosis of diabetes mellitus. Among 164 696 surveyed individuals, 8967 adults ≤64 years old reported having diabetes mellitus, representing 13.1 million individuals annually across the United States. The mean age was 51.6 years (SD 10.3), and 49.1% were female. A total of 41.1% were part of families that reported having financial hardship from medical bills, with 15.6% reporting an inability to pay medical bills at all. In multivariate analyses, individuals who lacked insurance, were non-Hispanic black, had low income, or had high-comorbidity burden were at higher odds of being in families with financial hardship from medical bills. When comparing the graded categories of financial hardship, there was a stepwise increase in the prevalence of high financial distress, food insecurity, cost-related nonadherence, and foregone/delayed medical care, reaching 70.5%, 49.4%, 49.5%, and 74% among those unable to pay bills, respectively. Compared with those without diabetes mellitus, individuals with diabetes mellitus had higher odds of financial hardship from medical bills (adjusted odds ratio [aOR], 1.27 [95% CI, 1.18–1.36]) or any of its consequences, including high financial distress (aOR, 1.14 [95% CI, 1.05–1.24]), food insecurity (aOR, 1.27 [95% CI, 1.16–1.40]), cost-related medication nonadherence (aOR, 1.43 [95% CI, 1.30–1.57]), and foregone/delayed medical care (aOR, 1.30 [95% CI, 1.20–1.40]). Conclusions: Nonelderly patients with diabetes mellitus have a high prevalence of financial hardship from medical bills, with deleterious consequences.

Financial Hardship and the Economic Effect of Childhood Cancer Survivorship

2018 ◽  
Vol 36 (21) ◽  
pp. 2198-2205 ◽  
Author(s):  
Paul C. Nathan ◽  
Tara O. Henderson ◽  
Anne C. Kirchhoff ◽  
Elyse R. Park ◽  
K. Robin Yabroff
Keyword(s):  
Health Care ◽  
Cancer Survivors ◽  
Childhood Cancer ◽  
Economic Effect ◽  
Adult Survivors ◽  
Childhood Cancer Survivors ◽  
Safety Net ◽  
Elevated Risk ◽  
Financial Hardship ◽  
Data Infrastructure

In addition to the long-term physical and psychological sequelae of cancer therapy, adult survivors of childhood cancer are at an elevated risk for financial hardship. Financial hardship can have material, psychological, and behavioral effects, including high out-of-pocket medical costs, asset depletion and debt, limitations in or inability to work, job lock, elevated stress and worry, and a delaying or forgoing of medical care because of cost. Most financial hardship research has been conducted in survivors of adult cancers. The few studies focused on childhood cancer survivors have shown that these individuals are at elevated risk for having difficulties with affording needed health care and report high out-of-pocket medical expenses, difficulty with paying medical bills, or consideration of filing for bankruptcy. Childhood cancer survivors are more likely to be unable to work or to have missed work because of poor health. They are more likely to report difficulties with obtaining insurance coverage and rely more frequently on government-sponsored insurance. Globally, countries able to provide curative cancer therapies have witnessed a growing population of survivors, which places a burden on their health care systems because survivors are more likely to require hospitalization and experience a higher burden of chronic illness than the general population. Guidelines for surveillance for late effects are intended to reduce the burden of morbidity, but research is needed to determine whether such surveillance is cost effective. Of note, risk-based survivor care should include routine surveillance for financial hardship. Improved measures of financial hardship, enhanced data infrastructure, and research studies to identify survivors and families most vulnerable to financial hardship and adverse health outcomes will inform the development of targeted programs to serve as a safety net for those at greatest risk.

Financial Hardship from Medical Bills Among Adults with Chronic Liver Diseases: National Estimates from the United States

Hepatology ◽  
2021 ◽  
Author(s):  
Carlos Lago‐Hernandez ◽  
Nghia H. Nguyen ◽  
Rohan Khera ◽  
Rohit Loomba ◽  
Sumeet K. Asrani ◽  
...  
Keyword(s):  
United States ◽  
Liver Diseases ◽  
The United States ◽  
Chronic Liver ◽  
Financial Hardship ◽  
Chronic Liver Diseases ◽  
National Estimates ◽  
Medical Bills

scholarly journals FINANCIAL HARDSHIP FROM MEDICAL BILLS AMONG PATIENTS WITH HEART FAILURE IN THE UNITED STATES

2021 ◽  
Vol 77 (18) ◽  
pp. 785
Author(s):  
Hyeon-Ju Ali ◽  
Javier Valero Elizondo ◽  
Stephen Yishu Wang ◽  
Arvind Bhimaraj ◽  
Safi Khan ◽  
...  
Keyword(s):  
United States ◽  
Heart Failure ◽  
The United States ◽  
Financial Hardship ◽  
Patients With Heart Failure ◽  
Medical Bills

Health insurance literacy, financial hardship and financial sacrifices among cancer survivors in the United States.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 1560-1560
Author(s):  
Jingxuan Zhao ◽  
Xuesong Han ◽  
Zhiyuan Zheng ◽  
Matthew P. Banegas ◽  
Donatus U. Ekwueme ◽  
...  
Keyword(s):  
United States ◽  
Health Insurance ◽  
Cancer Survivors ◽  
Financial Burden ◽  
Age Groups ◽  
The United States ◽  
Financial Hardship ◽  
Adult Cancer Survivors ◽  
Health Insurance Literacy ◽  
Medical Bills

1560 Background: Rising costs of cancer care have imposed substantial financial burden on cancer survivors. To date, little is known about the associations between potentially modifiable patient characteristics, including health insurance literacy (HIL), on financial burden among cancer survivors. This study aimed to evaluate the associations between HIL and financial hardship and financial sacrifices among adult cancer survivors in the United States. Methods: We identified 914 adult cancer survivors from the 2016 Medical Expenditure Panel Survey Experiences with Cancer Questionnaire. HIL was measured based on the question “Did you ever have a problem understanding health insurance or medical bills related to your cancer, its treatment, or the lasting effects of that treatment?” Medical financial hardship was measured in three domains—1) material (e.g. problems paying medical bills); 2) psychological (e.g. worry about large medical bills); and 3) behavioral (e.g. delay or forego healthcare because of cost). Financial sacrifices were based on questions related to changes in spending on vacation or leisure activities. We used multivariable logistic regression modeling to separately evaluate the associations between HIL problems and 1) financial hardship and 2) financial sacrifices. Results: 18.9% cancer survivors aged 18-64 years and 14.6% survivors ≥65 years reported HIL problems. Regardless of age groups, cancer survivors with HIL problems were more likely to report any material (OR =3.2; 95% CI:1.9-5.2) or psychological (OR=7.2; 95% CI: 4.1-12.7) financial hardship than those without the problems, as well as more likely to delay or forgo multiple medical care due to cost, including prescription medicine (OR=3.6; 95% CI: 1.8-7.1), specialist visit (OR=2.6; 95% CI: 1.2-5.8), and follow-up care (OR=2.1, 95% CI 1.2-4.0). Higher likelihood of reporting all measures of financial sacrifices were observed among those with HIL problems in both age groups (all p<0.05). Conclusions: Cancer survivors with HIL problems were more likely to report financial hardship and financial sacrifices than those without the problems. Improving HIL may help mitigate financial hardship.

Risk of cancer in first-degree relatives of childhood cancer patients: A linked longitudinal population-based registry study.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 1522-1522
Author(s):  
Laura-Maria Madanat-Harjuoja ◽  
Janne Pitkäniemi ◽  
Elli Hirvonen ◽  
Nea Malila ◽  
Lisa Diller
Keyword(s):  
Childhood Cancer ◽  
Cancer Patients ◽  
Cancer Registry ◽  
Bone Tumor ◽  
Early Onset ◽  
Index Case ◽  
Population Based ◽  
Elevated Risk ◽  
Malignant Bone Tumor ◽  
Risk Of Cancer

1522 Background: Population based data on risk of cancer in relatives of childhood cancer patients are sparse. Using linked population-based registries, we set out to evaluate risk of early onset cancer in first-degree relatives of childhood cancer patients. Methods: We queried the Finnish Cancer Registry and ascertained a cohort of 9135 individuals diagnosed with at least one cancer under the age of 21 years between 1970 and 2012. We then went on to identify a total of 58,211 unique first- and second-degree relatives by linking to the Central Population Registry. Relatives were then linked back to the annually updated Finnish Cancer Registry to identify cancer diagnoses in siblings, offspring and parents of childhood cancer patients, restricting to cancers occurring under the age of 40. Risk of cancer in relatives of the index case was estimated using standardized incidence ratios (SIRs) comparing cancer age and period specific incidence in relatives to that of the general population. Results: A total of 288 cancers were diagnosed in relatives during the 900,907 years of follow-up, while 266 cancers were expected. The overall risk of cancer in siblings of childhood cancer patients was elevated (SIR 1.18 95% CI 1.00-1.39). 144 of the childhood cancer patients were identified as having a sibling additional to index case with a diagnosis of cancer at age < 40; 44 of these 144 also had a parent with early onset cancer. The risk of early onset cancer was elevated in offspring overall (SIR 1.79 95%CI 1.05-2.81) and in offspring of retinoblastoma, malignant bone tumor and neuroblastoma patients. Siblings of lymphoma patients were at elevated risk of early cancer, and the mothers of 11 of 27 sibling pairs (lymphoma + cancer < 40 yo) also had cancer at age < 40. Conclusions: Linked registries allow family history of cancer to be evaluated across multiple relatives and to be longitudinally updated. Results are generally reassuring with regard to risk of cancer in relatives of childhood cancer patients. Elevated risk in relatives of retinoblastoma and malignant bone tumor patients are in line with the known cancer syndromes associated with these tumor types, and lymphoma and neuroblastoma families need further analysis.

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