Advertisement

Supportive Care in Cancer

, Volume 24, Issue 11, pp 4739–4746 | Cite as

The impact of cancer diagnosis and treatment on employment, income, treatment decisions and financial assistance and their relationship to socioeconomic and disease factors

  • Christine PaulEmail author
  • Allison Boyes
  • Alix Hall
  • Alessandra Bisquera
  • Annie Miller
  • Lorna O’Brien
Original Article

Abstract

Purpose

The financial impact of cancer diagnosis and treatment can be considerable to individuals and their households, leading to changes in treatment decision making. This study aimed to quantify effects on income and employment; describe how cost-related factors influence treatment decision making and need for financial assistance; and to identify patient sociodemographic factors associated with treatment decision making, use of financial assistance and financial effects.

Methods

A cross-sectional self-report questionnaire was administered to oncology outpatients from two hospitals in Australia: one regional and one metropolitan.

Results

Of 255 participants, 67 % indicated a change in employment and 63 % of those reported reduced household income since their diagnosis. Travel (15 %), loss of income (14 %) and cost of treatments (11 %) were commonly cited factors influencing treatment decision making. Seventy-four percent of participants reported that they did not access financial assistance, with more than a third (37 %) of those being unaware that financial assistance was available. Being currently not employed and more recent diagnosis were associated with a reduced income since diagnosis. After adjusting for employment status and age, patients with private health insurance had higher odds of reporting that financial factors had influenced treatment decision making (OR = 2.5).

Conclusion

Unemployment is a major driver of the financial impact of cancer. The costs of treatment may be particularly challenging for those with private health insurance who are more likely to be treated in the private health system where out-of-pocket costs are greater. Improved access to financial assistance is required to better avoid potential inequities.

Keywords

Cancer Oncology Treatment Decision making Employment Cross-sectional studies 

Notes

Acknowledgments

This research was supported by a National Health & Medical Research Council Project Grant (ID 1010536), a Strategic Research Partnership Grant (CSR 11-02) from Cancer Council NSW to the Newcastle Cancer Control Collaborative (New-3C) and infrastructure funding from the Hunter Medical Research Institute (HMRI). Christine Paul is supported by an NHMRC Career Development Fellowship (APP1061335). Allison Boyes is supported by National Health & Medical Research Council (APP1073317) and Cancer Institute NSW (13/ECF/1-37) Early Career Fellowships.

Our thanks go to the participating cancer treatment centres; the patients who kindly completed the survey; Rochelle Smits, Alison Zucca, Heidi Turon and Hannah Small for research support; and Sandra Dowley for data management.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest.

References

  1. 1.
    Sharp L, Timmons A (2010) The financial impact of a cancer diagnosis. National Cancer Registry and the Irish Cancer Society. http://hse.openrepository.com/hse/handle/10147/188292. Accessed 10 October 2015.Google Scholar
  2. 2.
    Longo C, Deber R, Fitch M, Williams A, D’Souza D (2007) An examination of cancer patients’ monthly ‘out-of-pocket’ costs in Ontario, Canada. Eur J Cancer Care 16(6):500–507CrossRefGoogle Scholar
  3. 3.
    Bernard DS, Farr SL, Fang Z (2011) National estimates of out-of-pocket health care expenditure burdens among nonelderly adults with cancer: 2001 to 2008. J Clin Oncol 29(20):2821–2826CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Short PF, Moran JR, Punekar R (2011) Medical expenditures of adult cancer survivors aged <65 years in the United States. Cancer 117(12):2791–2800CrossRefPubMedGoogle Scholar
  5. 5.
    Economics A (2007) Cost of cancer in NSW. Cancer Council NSW, WolloomoolooGoogle Scholar
  6. 6.
    OECD (2015) Health at a glance 2015: OECD indicators. OECD Publishing, Paris. http://dx.doi.org/10.1787/health_glance-2015-enGoogle Scholar
  7. 7.
    Short PF, Vasey JJ, Tunceli K (2005) Employment pathways in a large cohort of adult cancer survivors. Cancer 103(6):1292–1301CrossRefPubMedGoogle Scholar
  8. 8.
    Kessler RC, Greenberg PE, Mickelson KD, Meneades LM, Wang PS (2001) The effects of chronic medical conditions on work loss and work cutback. J Occup Environ Med 43(3):218–225CrossRefPubMedGoogle Scholar
  9. 9.
    Mehnert A (2011) Employment and work-related issues in cancer survivors. Crit Rev Oncol Hematol 77(2):109–130CrossRefPubMedGoogle Scholar
  10. 10.
    Zajacova A, Dowd J, Schoeni R, Wallace R (2015) Employment and income losses among cancer survivors: estimates from a national longitudinal survey of American families. Cancer 121(4):4425–4432CrossRefPubMedGoogle Scholar
  11. 11.
    Himmelstein DU, Warren E, Thorne D, Woolhandler S (2005) MarketWatch: illness and injury as contributors to bankruptcy [published online February 2005]. Health Aff (Millwood)Google Scholar
  12. 12.
    Markman M, Luce R (2010) Impact of the cost of cancer treatment: an internet-based survey. J Oncol Practice 6(2):69–73CrossRefGoogle Scholar
  13. 13.
    Longo CJ, Fitch M, Deber RB, Williams AP (2006) Financial and family burden associated with cancer treatment in Ontario, Canada. Support Care Cancer 14:1077–1085CrossRefPubMedGoogle Scholar
  14. 14.
    Irwin B, Kimmick G, Altomare I, Marcom PK, Houck K, Zafar SY, Peppercorn J (2014) Patient experience and attitudes toward addressing the cost of breast cancer care. Oncologist 19(11):1135–1140CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Hall A, Campbell HS, Sanson-Fisher R, Lynagh M, D’Este C, Burkhalter R, Carey M (2013) Unmet needs of Australian and Canadian haematological cancer survivors: a cross-sectional international comparative study. Psychooncology 22(9):2032–2038CrossRefPubMedGoogle Scholar
  16. 16.
    Hall A, D’Este C, Tzelepis F, Lynagh M, Sanson-Fisher R (2014) Factors associated with haematological cancer survivors experiencing a high level of unmet need across multiple items of supportive care: a cross-sectional survey study. Support Care Cancer 22(11):2899–2909CrossRefPubMedGoogle Scholar
  17. 17.
    Weaver KE, Rowland JH, Bellizzi KM, Aziz NM (2010) Forgoing medical care because of cost: assessing disparities in healthcare access among cancer survivors living in the United States. Cancer 116(14):3493–3504CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Zullig LL, Peppercorn JM, Schrag D, Taylor DH, Lu Y, Samsa G, Abernethy AP, Zafar SY (2013) Financial distress, use of cost-coping strategies, and adherence to prescription medication among patients with cancer. J Oncol Pract 9(6S):60s–63sCrossRefPubMedCentralGoogle Scholar
  19. 19.
    Paul C, Bonevski B, Twyman L, D’Este C, Siahpush M, Guillaumier A, Bryant J, Fradgley E, Palazzi K (2015). The ‘price signal’ for health care is loud and clear: a cross-sectional study of self-reported access to health care by disadvantaged Australians. Aust N Z J Public Health [Accepted for publication, 2015]Google Scholar
  20. 20.
    Department of Human Services Medicare services. (2015) Australian Government. http://www.humanservices.gov.au/customer/subjects/medicare-services. Accessed 10 November 2015Google Scholar
  21. 21.
    Department of Human Services (2015) Payments for people living with illness, injury or disability. Australian Government. http://www.humanservices.gov.au/customer/subjects/payments-for-people-living-with-illness-or-disability. Accessed 21 December 2015.Google Scholar
  22. 22.
    McGrath P (2000) “It’s horrendous-but really, what can you do?” Preliminary findings on financial impact of relocation for specialist treatment. Aust Health Rev 23(3):94–103CrossRefPubMedGoogle Scholar
  23. 23.
    McGrath P, Seguerra J (2000) The patient transit assistance scheme: a consumer’s perspective. Aust J Rural Health 8(4):232–238CrossRefPubMedGoogle Scholar
  24. 24.
    Thomson S, Osborn R, Squires D, Jun M, (editors) (2012) International profiles of health care systems, The Commonwealth Fund 2012 New York, NY and Washington, DCGoogle Scholar
  25. 25.
    Penchansky R (1977) The concept of access: a definition. National Health Planning Information CenterGoogle Scholar
  26. 26.
    Armstrong BK, Gillespie JA, Leeder SR, Rubin GL, Russell LM (2007) Challenges in health and health care for Australia. Med J Aust 187(9):485PubMedGoogle Scholar
  27. 27.
    Taskila T, Lindbohm M (2007) Factors affecting cancer survivors’ employment and work ability. Acta Oncol 46(4):446–451CrossRefPubMedGoogle Scholar
  28. 28.
    Timmons A, Gooberman-Hill R, Sharp L (2013) “It’s at a time in your life when you are most vulnerable”: a qualitative exploration of the financial impact of a cancer diagnosis and implications for financial protection in health. PLoS One 8(11):e77549CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Hewitt M, Greenfield S, Stovall E, eds (2006) From cancer patient to cancer survivor: lost in transition. Committee on Cancer Survivorship: Improving Care and Quality of Life, Institute of Medicine and National Research Council. The National Academies Press. http://www.nap.edu/catalog/11468.html. Accessed 10 November 2015Google Scholar
  30. 30.
    Kelly M. John Grayson is searching for answers. Newcastle Herald [Newspaper on the internet]. 2015 June 5 [cited 2015 November 10]. Available from: http://www.theherald.com.au/story/3126312/john-grayson-is-searching-for-answers/.Google Scholar
  31. 31.
    Department of Human Services (2016) Increase the Age Pension qualifying age to 70 years. Australian Government. https://www.humanservices.gov.au/corporate/budget/budget-2014-15/budget-measures/older-australians/increase-age-pension-qualifying-age-70-years. Accessed 12 February 2016Google Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • Christine Paul
    • 1
    • 2
    Email author
  • Allison Boyes
    • 1
    • 2
  • Alix Hall
    • 1
    • 2
  • Alessandra Bisquera
    • 3
  • Annie Miller
    • 4
  • Lorna O’Brien
    • 4
  1. 1.School of Medicine and Public HealthUniversity of NewcastleCallaghanAustralia
  2. 2.Priority Research Centre for Health BehaviourHunter Medical Research InstituteNew Lambton HeightsAustralia
  3. 3.Clinical Research Design, Information Technology and Statistical SupportHunter Medical Research InstituteNew Lambton HeightsAustralia
  4. 4.Cancer Council NSWSydneyAustralia

Personalised recommendations