Adult survivors of childhood cancer face a multitude of health-related problems in the post-treatment period, due to potential treatment-related side effects such as heart disease, kidney impairment, and secondary cancers. They may experience higher out-of-pocket healthcare costs, which can lead to an excessive financial burden. Recently, investigators of the Childhood Cancer Survivor Study concluded that, in this population, mounting medical bills can potentially trigger patient behaviors that are intended to cut costs but which can have serious negative health consequences.1
The study, published online in August in the Journal of Clinical Oncology, showed that this population of survivors with higher out-of-pocket costs experienced an eight-fold increase in difficulty handling their medical bills—and the “financial toxicity” of this situation led to further health risks.1
Lead author Ryan Nipp, MD, of Massachusetts General Hospital, commented, “Survivors who reported spending a higher percentage of their income on out-of-pocket medical costs were not only more likely to report financial burden, they also were at risk for undertaking behaviors potentially detrimental to their health in order to save money. While studies have identified associations between financial burden and patients treatment outcomes, quality of life and even survival among adults with cancer, as far as we know, this is the first to report these associations in survivors of childhood cancer.”2
The investigators found that 10% of an age-stratified random sample of 580 childhood cancer survivors (who had received their initial diagnosis an average of 30 years earlier) experienced out-of-pocket costs exceeding 10% or more of their total household income, compared with only 2.9% of 173 siblings who were not affected by cancer. Most of the survivors were of low-income status and had been hospitalized within the previous year. As a result of the financial burden they experienced, many in this population reported engaging in risky behaviors aimed at lowering their healthcare costs—including missed treatments, tests, and follow-up appointments; delayed medical care; and not taking medications as prescribed.1
It is unclear to what degree the Affordable Care Act may have affected the financial burden of these survivors, since the study was completed before the Act was fully implemented. During the time that the study was conducted, insurance plans implemented higher patient out-of-pocket costs in the form of increased deductibles, copays, and coinsurance, all of which were seen to cause a financial burden in this population.2
Commenting on the study findings, Dr. Nipp emphasized that “A more comprehensive understanding of the relationship between high out-of-pocket medical costs and the adverse effects of increased financial burden on cancer survivors could be instrumental in helping us identify those at risk for higher costs to help us address their financial challenges and improve health outcomes. It could also help inform policy changes to help meet the unique needs of cancer survivors and improve our understanding of how both higher costs and resulting financial burden influence patients’ approach to their medical care and decision-making.”2
Are any of your patients dealing with these financial issues currently?
1. Nipp RD, Kirschhoff AC, Fair D, et al. Financial burden in survivors of childhood cancer: a report from the Childhood Cancer Survivor Study. J Clin Oncol. 2017 August 17. [Epub before print]
2. Out-of-pocket health costs can lead to financial problems for survivors of childhood cancer [news release]. Boston, MA: Massachusetts General Hospital Department of Public Affairs; August 22, 2017. http://www.massgeneral.org/News/pressrelease.aspx?id=2138 . Accessed September 26, 2017.