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Association of co-morbidities with financial hardship in survivors of adult cancer

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Abstract

Purpose

To evaluate the impact of co-morbidities on financial hardship in adult cancer survivors and the role of health insurance and a usual source of care (i.e., a particular doctor’s office/health center/other place that the person usually goes if he/she is sick or needs advice) in relieving this impact.

Methods

Using the Medical Expenditure Panel Survey, we estimated prevalence of two financial hardships, out-of-pocket (OOP) burden and financial worry, among 1196 adult cancer survivors. A modified Charlson co-morbidity index (CCI) assessed co-morbidities, which represent a medical event (e.g., a doctor’s appointment) associated with co-morbid conditions within the past 1 year. Multivariable logistic regression tested the influence of health insurance and a usual source of care on associations of co-morbidities with financial hardship by middle/high vs. low-income families and by working vs. retirement-age individuals.

Results

Years since cancer diagnosis ranged from 0 to 76 years (mean: 10.3, SD: 9.8), 10 and 25% of survivors experienced OOP burden and financial worry. For OOP burden, increased CCI was a risk factor among survivors of low-income families, ORs: 1.91 (95% CI: 1.06, 3.46) for a CCI 1–2 and 3.37 (95% CI: 1.72, 6.61) for a CCI ≥ 3 vs. CCI of 0. For financial worry, increased CCI was a risk factor among working-age survivors, ORs: 1.58 (95% CI: 1.02, 2.47) for a CCI 1–2 and 2.15 (95% CI: 1.19, 3.87) for a CCI ≥ 3 vs. CCI of 0. However, having health insurance and a usual source of care did not mitigate impact of co-morbidities on financial hardship (P values > 0.05).

Conclusions

Impact of co-morbidities on OOP and financial worry burden was greatest in survivors of low-income families and working-age, respectively. Health insurance and a usual source of care did not relieve the impact of co-morbidities on financial hardship.

Implications

Effective strategies are warranted to mitigate financial hardship for survivors.

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Data availability

De-identified, publicly available data are available through US CDC MEPS website.

Code availability

Codes created for data analyses are available upon a request.

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Author information

Authors and Affiliations

  1. Rutgers New Jersey Medical School, Newark, NJ, USA

    Matthew J. Fastiggi

  2. Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, MS735, 262 Danny Thomas Place, TN, 38105, Memphis, USA

    Jin-ah Sim & I-Chan Huang

Authors
  1. Matthew J. Fastiggi
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  2. Jin-ah Sim
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  3. I-Chan Huang
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Contributions

MJF assisted in the assembly of data, data analysis, and results interpretation, and drafted the manuscript.

JAS assisted in administrative support, the assembly of data, results interpretation, and manuscript revision. ICH conceptualized and designed the study; provided administrative support; assisted in collection and assembly of data, data analysis, and result interpretation; and drafted the manuscript.

All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to I-Chan Huang.

Ethics declarations

Ethical approval

This manuscript comports with the St. Jude Children’s Research Hospital’s Institutional Review Board as exempt status from human subjects research (45 CFR 46.104(d) (4): secondary research for which consent is not required).

Consent to participants

This research used de-identified, publicly available data sets from federal government (US CDC MEPS program) that did not involve human subjects. This manuscript does not contain any studies with human participants performed by any of the authors. Therefore, this research did not involve the content to participants.

Consent for publication

This research used de-identified, publicly available data sets that are allowed for publication.

Conflict of interest

The authors declare no competing interests.

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Fastiggi, M.J., Sim, Ja. & Huang, IC. Association of co-morbidities with financial hardship in survivors of adult cancer. Support Care Cancer 29, 7355–7364 (2021). https://doi.org/10.1007/s00520-021-06313-7

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  • DOI: https://doi.org/10.1007/s00520-021-06313-7

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