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Predictors of financial difficulties and work modifications among cancer survivors in the United States

Journal of Cancer Survivorship volume 10, pages 241–250 (2016)Cite this article

Abstract

Purpose

The aim of this study is to examine predictors of cancer-related financial difficulties and work modifications in a national sample of cancer survivors.

Methods

Using the 2011 Medical Expenditure Panel Survey and Experiences with Cancer Survivorship Supplement, the prevalence of financial difficulties and work modifications was examined. Logistic regression and survey weights were used to model these outcomes as functions of sociodemographic and health covariates separately among survivors in active treatment and survivors under age 65 years.

Results

Among all survivors, 33.2 % reported any financial concern, with 17.9 % reporting financial difficulties such as debt or bankruptcy. Among working survivors, 44.0 % made any work modification and 15.3 % made long-term work modifications (e.g., delayed or early retirement). Among those in active treatment, predictors of financial difficulty included: race/ethnicity other than white, non-Hispanic [OR = 8.0; 95 % CI 2.2–28.4]; income <200 % of federal poverty level (FPL) [OR = 15.7; 95 % CI 2.6–95.2] or between 200 and 400 % of FPL [OR = 8.2; 95 % CI 1.3–51.4]; residence in a non-metropolitan service area [OR = 6.4; 95 % CI 1.6–25.0]; and good/fair/poor self-rated health [OR = 3.8; 95 % CI 1.0–14.2]. Among survivors under age 65 years, predictors of long-term work modifications included good/fair/poor self-rated health [OR = 4.1; 95 % CI 1.6–10.2], being married [OR = 2.2; 95 % CI 1.0–4.7], uninsured [OR = 3.5; 95 % CI 1.3–9.3], or publicly insured [OR = 9.0; 95 % CI 3.3–24.4].

Conclusions

A substantial proportion of cancer survivors experience cancer-related financial difficulties and work modifications, particularly those who report race/ethnicity other than white, non-Hispanic, residence in non-metropolitan areas, worse health status, lower income, and public or no health insurance.

Implications for cancer survivors

Attention to the economic impact of cancer treatment is warranted across the survivorship trajectory, with particular attention to subgroups at higher risk.

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References

  1. NCI. Dictionary of cancer terms. http://www.cancer.gov/dictionary?cdrid=450125 Accessed November 12 2014.

  2. Mariotto AB, Yabroff KR, Shao Y, Feuer EJ, Brown ML. Projections of the cost of cancer care in the United States: 2010–2020. J Natl Cancer Inst. 2011;103(2):117–28. doi:10.1093/jnci/djq495.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Arozullah AM, Calhoun EA, Wolf M, Finley DK, Fitzner KA, Heckinger EA, et al. The financial burden of cancer: estimates from a study of insured women with breast cancer. J Support Oncol. 2004;2(3):271–8.

    PubMed  Google Scholar 

  4. Banegas MP, Yabroff KR. Out of pocket, out of sight? An unmeasured component of the burden of cancer. J Natl Cancer Inst. 2013;105(4):252–3. doi:10.1093/jnci/djs641.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Tang DH, Alberts DS, Nevins R, Sullivan S, Skrepnek GH. Health care expenditures, hospitalizations, and productivity associated with cancer in US employer settings. J Occup Environ Med Am Coll Occup Environ Med. 2012;54(12):1453–60. doi:10.1097/JOM.0b013e31827943e0.

    Article  Google Scholar 

  6. Zafar SY, Peppercorn JM, Schrag D, Taylor DH, Goetzinger AM, Zhong X, et al. The financial toxicity of cancer treatment: a pilot study assessing out-of-pocket expenses and the insured cancer patient’s experience. Oncologist. 2013;18(4):381–90. doi:10.1634/theoncologist.2012-0279.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Finkelstein EA, Tangka FK, Trogdon JG, Sabatino SA, Richardson LC. The personal financial burden of cancer for the working-aged population. Am J Manag Care. 2009;15(11):801–6.

    PubMed  Google Scholar 

  8. Dowling EC, Chawla N, Forsythe LP, de Moor J, McNeel T, Rozjabek HM, et al. Lost productivity and burden of illness in cancer survivors with and without other chronic conditions. Cancer. 2013;119(18):3393–401. doi:10.1002/cncr.28214.

    Article  PubMed  Google Scholar 

  9. Shankaran V, Jolly S, Blough D, Ramsey SD. Risk factors for financial hardship in patients receiving adjuvant chemotherapy for colon cancer: a population-based exploratory analysis. J Clin Oncol. 2012;30(14):1608–14.

    Article  PubMed  Google Scholar 

  10. Ramsey S, Blough D, Kirchhoff A, Kreizenbeck K, Fedorenko C, Snell K, et al. Washington State cancer patients found to be at greater risk for bankruptcy than people without a cancer diagnosis. Health Aff (Project Hope). 2013;32(6):1143–52. doi:10.1377/hlthaff.2012.1263.

    Article  Google Scholar 

  11. Guy Jr GP, Ekwueme DU, Yabroff KR, Dowling EC, Li C, Rodriguez JL, et al. Economic burden of cancer survivorship among adults in the United States. J Clin Oncol Off J Am Soc Clin Oncol. 2013;31(30):3749–57. doi:10.1200/jco.2013.49.1241.

    Article  Google Scholar 

  12. Azzani M, Roslani AC, Su TT. The perceived cancer-related financial hardship among patients and their families: a systematic review. Support Care Cancer Off J Multinational Assoc Support Care Cancer. 2014. doi:10.1007/s00520-014-2474-y.

    Google Scholar 

  13. Kent EE, Forsythe LP, Yabroff KR, Weaver KE, de Moor JS, Rodriguez JL, et al. Are survivors who report cancer-related financial problems more likely to forgo or delay medical care? Cancer. 2013;119(20):3710–7. doi:10.1002/cncr.28262.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Meneses K, Azuero A, Hassey L, McNees P, Pisu M. Does economic burden influence quality of life in breast cancer survivors? Gynecol Oncol. 2012;124(3):437–43. doi:10.1016/j.ygyno.2011.11.038.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Sharp L, Carsin AE, Timmons A. Associations between cancer-related financial stress and strain and psychological well-being among individuals living with cancer. Psycho-Oncology. 2013;22(4):745–55. doi:10.1002/pon.3055.

    Article  PubMed  Google Scholar 

  16. Weaver KE, Rowland JH, Bellizzi KM, Aziz NM. Forgoing medical care because of cost: assessing disparities in healthcare access among cancer survivors living in the United States. Cancer. 2010;116(14):3493–504. doi:10.1002/cncr.25209.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Shih YC, Ganz PA, Aberle D, Abernethy A, Bekelman J, Brawley O, et al. Delivering high-quality and affordable care throughout the cancer care continuum. J Clin Oncol Off J Am Soc Clin Oncol. 2013;31(32):4151–7. doi:10.1200/JCO.2013.51.0651.

    Article  Google Scholar 

  18. Ekwueme DU, Yabroff KR, Guy Jr GP, Banegas MP, de Moor JS, Li C, et al. Medical costs and productivity losses of cancer survivors—United States, 2008–2011. MMWR Morb Mortal Wkly Rep. 2014;63(23):505–10.

    PubMed  Google Scholar 

  19. Guy Jr GP, Yabroff KR, Ekwueme DU, Smith AW, Dowling EC, Rechis R, et al. Estimating the health and economic burden of cancer among those diagnosed as adolescents and young adults. Health Aff (Project Hope). 2014;33(6):1024–31. doi:10.1377/hlthaff.2013.1425.

    Article  Google Scholar 

  20. Yabroff KR, Dowling E, Rodriguez J, Ekwueme DU, Meissner H, Soni A, et al. The medical expenditure panel survey (MEPS) experiences with cancer survivorship supplement. J Cancer Surviv Res Pract. 2012;6(4):407–19. doi:10.1007/s11764-012-0221-2.

    Article  Google Scholar 

  21. AHRQ. Medical Expenditures Panel Survey background. http://meps.ahrq.gov/mepsweb/about_meps/survey_back.jsp. Accessed November 5 2014.

  22. CDC. MEPS experiences with cancer survivorship supplement. http://www.cdc.gov/cancer/survivorship/what_cdc_is_doing/meps.htm. Accessed November 5 2014.

  23. AHRQ. http://meps.ahrq.gov/survey_comp/hc_response_rate.jsp. Accessed November 5 2014.

  24. National Cancer Institute. http://appliedresearch.cancer.gov/meps/meps_fact_sheet.pdf. Accessed November 5 2014.

  25. Yabroff KR, Lund J, Kepka D, Mariotto A. Economic burden of cancer in the United States: estimates, projections, and future research. Cancer Epidemiol Biomark Prev. 2011;20(10):2006–14.

    Article  Google Scholar 

  26. Bhandari A, Wagner T. Self-reported utilization of health care services: improving measurement and accuracy. Med Care Res Rev. 2006;63(2):217–35.

    Article  PubMed  Google Scholar 

  27. Meropol NJ, Schrag D, Smith TJ, Mulvey TM, Langdon Jr RM, Blum D, et al. American Society of Clinical Oncology guidance statement: the cost of cancer care. J Clin Oncol Off J Am Soc Clin Oncol. 2009;27(23):3868–74. doi:10.1200/jco.2009.23.1183.

    Article  Google Scholar 

  28. Irwin B, Kimmick G, Altomare I, Marcom PK, Houck K, Zafar Y, et al. Patient experience and attitudes toward addressing the cost of breast cancer care. Oncologist. 2014. doi:10.1634/theoncologist.2014-0117.

    PubMed  PubMed Central  Google Scholar 

  29. de Souza JA, Wong YN. Financial distress in cancer patients. J Med Person. 2013;11(2). doi:10.1007/s12682-013-0152-3.

  30. Bestvina CM, Zullig LL, Rushing C, Chino F, Samsa GP, Altomare I, et al. Patient-oncologist cost communication, financial distress, and medication adherence. J Oncol Pract Am Soc Clin Oncol. 2014;10(3):162–7. doi:10.1200/jop.2014.001406.

    Article  Google Scholar 

  31. Moriates C, Shah NT, Arora VM. First, do no (financial) harm. JAMA J Am Med Assoc. 2013;310(6):577–8.

    CAS  Article  Google Scholar 

  32. Henrikson NB, Tuzzio L, Loggers ET, Miyoshi J, Buist DS. Patient and oncologist discussions about cancer care costs. Support Care Cancer. 2014;22(4):961–7.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Bullock AJ, Hofstatter EW, Yushak ML, Buss MK. Understanding patients' attitudes toward communication about the cost of cancer care. J Oncol Pract. 2012;8(4):e50–8.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Sommers R, Goold SD, McGlynn EA, Pearson SD, Danis M. Focus groups highlight that many patients object to clinicians’ focusing on costs. Health Aff. 2013;32(2):338–46.

    Article  Google Scholar 

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Conflicts of interest

The authors declare they have no conflicts of interest.

Funding

No funding was received for this research.

Author information

Affiliations

  1. Collaborative Cancer Care Research Group (3CRG), Betty Irene Moore School of Nursing, University of California, Davis, 4610 X Street #4202, Sacramento, CA, 95817, USA

    Robin L. Whitney, Janice F. Bell, Sarah C. Reed, Rebecca Lash, Richard J. Bold, Katherine K. Kim, Andra Davis, David Copenhaver & Jill G. Joseph

  2. Comprehensive Cancer Center, UC Davis Health System, University of California, Davis, 4501 X Street, Sacramento, CA, 95817, USA

    Richard J. Bold & David Copenhaver

Authors
  1. Robin L. Whitney
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  2. Janice F. Bell
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  3. Sarah C. Reed
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Correspondence to Robin L. Whitney.

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Whitney, R.L., Bell, J.F., Reed, S.C. et al. Predictors of financial difficulties and work modifications among cancer survivors in the United States. J Cancer Surviv 10, 241–250 (2016). https://doi.org/10.1007/s11764-015-0470-y

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  • DOI: https://doi.org/10.1007/s11764-015-0470-y

Keywords

  • Survivorship
  • Medical Expenditure Panel Survey
  • Financial burden
  • Employment issues