When the paradigm of surviving beyond active cancer treatment is considered, major dilemmas frequently cited are the fear of recurrence and the possibility of long-term sequelae. Rarely is financial hardship acknowledged.
A recent systematic literature review was published by National Cancer Institute colleagues.1 The authors detailed numerous indices of economic hardship such as increased out-of-pocket expenses, limitations in work ability with resultant wage decrease, productivity loss, reduced overall resources to pay for medical care and bills, use of savings, accrual of medical and credit card debt, loan procurement to pay for medical expenses, and bankruptcy.
Of note is that financial hardship also has emotional and behavioral sequelae. These include wage worry and financial anxiety that lead to treatment nonadherence and treatment delays to cost save which ultimately have negative effects on health outcomes. For example, survivors may skip, take less, or avoid filling prescriptions due to cost concerns. Additionally, they may reduce spending on noncancer related health care. This also has been evidenced in cancer caregivers where family members forego their medical care in response to financial worries. Despite a lack of congruence on terms and definitions of financial hardship as evidenced in this systematic review, the authors determined that nearly half of all cancer survivors (47% to 49%) experience some form of financial distress.1
Systematic analysis revealed that the majority of studies were published in the past 3 years. This contemporary acknowledgement of hardship offers testimony to an evolving realization of this burden of cancer survivorship. This has considerable importance as the future is pondered. With an increasing aging population, the number of cancer survivors is expected to increase to 18 million by 2022 (versus a current estimation of 14.5 million survivors).2 With an increasing majority of older cancer survivors, we can expect heightened financial hardship for those with fixed incomes unable to pay for expensive therapies not fully covered by insurance.
When a holistic view to cancer care is conceptualized, it often refers to the psychological and social corollaries in tandem with the biophysiological focus. It is timely that the financial implications of living beyond cancer are integrated into the comprehensive model of cancer survivorship. These concerns will assume a predominant role in the landscape of living fully beyond the active cancer experience. Social, political, and regulatory’s take note – a new future of cancer survivorship is upon us.
- Altice CK, Banegas MP, Tucker-Seeley RD, Yabroff KR. Financial Hardships Experienced by Cancer Survivors: A Systematic Review. J Natl Cancer Inst. 2016 Oct 17.
- de Moor JS, Mariotto AB, Parry C, et al. Cancer Survivors in the United States: Prevalence Across the Survivorship Trajectory and Implications for Care. Cancer Epidemiol Biomarkers Prev. 2013 Apr;22(4):561-70.