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Shared burden: the association between cancer diagnosis, financial toxicity, and healthcare cost-related coping mechanisms by family members of non-elderly patients in the USA

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Abstract

Purpose

There has been little research on the healthcare cost-related coping mechanisms of families of patients with cancer. Therefore, we assessed the association between a cancer diagnosis and the healthcare cost-related coping mechanisms of participant family members through their decision to forego or delay seeking medical care, one of the manifestations of financial toxicity.

Methods

Using data from the National Health Interview Survey (NHIS) between 2000 and 2018, sample weight-adjusted prevalence was calculated and multivariable logistic regressions defined adjusted odds ratios (aORs) for participant family members who needed but did not get medical care or who delayed seeking medical care due to cost in the past 12 months, adjusting for relevant sociodemographic covariates, including participant history of cancer (yes vs. no) and participant age (18–45 vs. 46–64 years old). The analysis of family members foregoing or delaying medical care was repeated using a cancer diagnosis * age interaction term.

Results

Participants with cancer were more likely than those without a history of cancer to report family members delaying (19.63% vs. 16.31%, P < 0.001) or foregoing (14.53% vs. 12.35%, P = 0.001) medical care. Participants with cancer in the 18 to 45 years old age range were more likely to report family members delaying (pinteraction = 0.028) or foregoing (pinteraction < 0.001) medical care. Other factors associated with cost-related coping mechanisms undertaken by the participants’ family members included female sex, non-married status, poorer health status, lack of health insurance coverage, and lower household income.

Conclusion

A cancer diagnosis may be associated with familial healthcare cost-related coping mechanisms, one of the manifestations of financial toxicity. This is seen through delayed/omitted medical care of family members of people with a history of cancer, an association that may be stronger among young adult cancer survivors. These findings underscore the need to further explore how financial toxicity associated with a cancer diagnosis can affect patients’ family members and to design interventions to mitigate healthcare cost-related coping mechanisms.

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Data sharing statement

The data is publicly available via IPUMS (https://www.ipums.org/).

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Funding

Funding grant number R01-CA240582 (PLN), NIH/NCI Cancer Center Support Grant P30 CA008748 (FC and ECD).

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Authors and Affiliations

  1. Department of Biology, Emory University, Atlanta, GA, USA

    Bahaa Kazzi

  2. Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 02446, USA

    Fumiko Chino & Edward Christopher Dee

  3. Department of Internal Medicine, Johns Hopkins University, Baltimore, MD, USA

    Brigitte Kazzi

  4. Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, MA, USA

    Bhav Jain

  5. Department of Radiation Oncology, Emory University School of Medicine, Atlanta, GA, USA

    Sibo Tian

  6. Department of Medicine, Einstein Medical Center, Philadelphia, PA, USA

    Joseph A. Paguio & J. Seth Yao

  7. Department of Radiation Oncology, Kaiser Permanente, Portland, OR, USA

    Vinayak Muralidhar

  8. Department of Radiation Oncology, University of Miami/Sylvester Comprehensive Cancer Center, Miami, FL, USA

    Brandon A. Mahal

  9. Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Paul L. Nguyen

  10. Department of Radiation Oncology, University of Texas Southwestern, 2280 Inwood Road, Dallas, TX, 75235, USA

    Nina N. Sanford

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  1. Bahaa Kazzi
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Contributions

Study concept and design: ECD, BK. Data analysis and interpretation: ECD, FC, BK, NNS. Manuscript preparation: ECD, NNS, BK, FC. Critical revision: All authors.

Corresponding authors

Correspondence to Nina N. Sanford or Edward Christopher Dee.

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IRB review exempt due to publicly available data.

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Only publicly available, de-identified data were used.

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Only publicly available, de-identified data were used.

Conflict of interest

Author BAM received funding from the Prostate Cancer Foundation and (PCF), the American Society for Radiation Oncology (ASTRO), the Department of Defense, and the Sylvester Comprehensive Cancer Center outside the submitted work. Author PLN received grants and personal fees from Bayer, Janssen, and Astellas and personal fees from Boston Scientific, Dendreon, Ferring, COTA, Blue Earth Diagnostics, Myovant Sciences, and Augmenix outside the submitted work. Author VM received a grant from the Conquer Cancer Foundation outside the submitted work. The remaining authors declare they have no financial interests.

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Nina N. Sanford and Edward Christopher Dee contributed as co-senior authors.

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Kazzi, B., Chino, F., Kazzi, B. et al. Shared burden: the association between cancer diagnosis, financial toxicity, and healthcare cost-related coping mechanisms by family members of non-elderly patients in the USA. Support Care Cancer 30, 8905–8917 (2022). https://doi.org/10.1007/s00520-022-07234-9

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