Skip to main content

Advertisement

SpringerLink
Log in

Financial Hardship—an Unwanted Consequence of Cancer Treatment

  • Health Economics (N Khera, Section Editor)
  • Published:
Current Hematologic Malignancy Reports Aims and scope Submit manuscript

Abstract

The substantial economic burden of cancer is increasingly being shifted to patients. Financial burden experienced by patients as a result of medical treatment has an impact on their lifestyle choices, health behaviors, and quality of life. Variation in treatment recommendations based on the patients’ economic status or affordability may be against the basic tenet of social justice and is a growing challenge for policy makers. This review summarizes the multifaceted constructs and current trends associated with financial hardship within the context of cancer care and healthcare economics focusing mainly on hematological malignancies but supplemented by nonhematological cancer and general medical literature. We also highlight the patient and physician perspectives about this issue and identify important areas for future research. We discuss the need for more proactive solutions so that patients can achieve good clinical outcomes, without catastrophic financial consequences for themselves and their families.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. Zafar SY, Abernethy A. Financial toxicity, Part I: a new name for a growing problem. Oncology (Williston Park). 2013;27(2):80–1.

    Google Scholar 

  2. 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. The number of under-insured cancer patients is increasing. This study outlines predictors of financial toxicity and emphasizes that having health insurance does not prevent patients from having financial distress or health disparities.

    Article  PubMed Central  PubMed  Google Scholar 

  3. 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 Off J Am Soc Clin Oncol. 2012;30(14):1608–14.

    Article  Google Scholar 

  4. Khera N, Chang YH, Hashmi S, Slack J, Beebe T, Roy V, et al. Financial burden in recipients of allogeneic hematopoietic cell transplantation. Biol Blood Marrow Transplant J Am Soc Blood Marrow Transplant. 2014;20(9):1375–81.

    Article  Google Scholar 

  5. Jagsi R, Pottow JAE, Griffith KA, Bradley C, Hamilton AS, Graff J, et al. Long-term financial burden of breast cancer: experiences of a diverse cohort of survivors identified through population-based registries. J Clin Oncol. 2014;24:2014.

    Google Scholar 

  6. 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. 32% of patients reported cancer-related financial problames making patinets more likely to forgo or delay their medical care. Factors found to be significantly associated with cancer-related financial problems were younger age at diagnosis, minority/race/ethnicity, history of chemotherapy or radiation treatment, recurrence or multiple cancer, and shorter time from diagnosis.

    PubMed  Google Scholar 

  7. Kodama Y, Morozumi R, Matsumura T, Kishi Y, Murashige N, Tanaka Y, et al. Increased financial burden among patients with chronic myelogenous leukaemia receiving imatinib in Japan: a retrospective survey. BMC Cancer. 2012;12:152.

    Article  PubMed Central  PubMed  Google Scholar 

  8. Langa KM, Fendrick AM, Chernew ME, Kabeto MU, Paisley KL, Hayman JA. Out-of-pocket health-care expenditures among older Americans with cancer. Value Health. 2004;7(2):186–94.

    Article  PubMed  Google Scholar 

  9. Majhail NS, Rizzo JD, Hahn T, Lee SJ, McCarthy PL, Ammi M, et al. Pilot study of patient and caregiver out-of-pocket costs of allogeneic hematopoietic cell transplantation. Bone Marrow Transplant. 2013;48(6):865–71.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  10. Selden TM, Kenney GM, Pantell MS, Ruhter J. Cost sharing in medicaid and CHIP: how does it affect out-of-pocket spending? Health Aff. 2009;28(4):w607–19.

    Article  Google Scholar 

  11. 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.

    Article  PubMed Central  PubMed  Google Scholar 

  12. Goodwin JA, Coleman EA, Sullivan E, Easley R, McNatt PK, Chowdhury N, et al. Personal financial effects of multiple myeloma and its treatment. Cancer Nurs. 2013;36(4):301–8.

    Article  PubMed Central  PubMed  Google Scholar 

  13. Hamilton JG, Wu LM, Austin JE, Valdimarsdottir H, Basmajian K, Vu A, et al. Economic survivorship stress is associated with poor health-related quality of life among distressed survivors of hematopoietic stem cell transplantation. Psycho-Oncology. 2013;22(4):911–21. This study showed that financial stress was associated with poor health related quality of life. More specifically, greater perceptions of financial and employment stress were associated with poorer physical, functional and transplant-specific functioning. Greater financial stress was also associated with poorer emotional functioning.

    Article  PubMed Central  PubMed  Google Scholar 

  14. Chino F, Peppercorn J, Taylor DH, Lu Y, Samsa G, Abernethy A, et al. Self-reportef financial burden and satisfaction wit care among patients with cancer. Oncologist. 2014;19:414–20.

    Article  PubMed Central  PubMed  Google Scholar 

  15. Khera N. Reporting and grading financial toxicity. J Clin Oncol Off J Am Soc Clin Oncol. 2014;32(29):3337–8.

    Article  Google Scholar 

  16. Fenn KM, Evans SB, McCorkle R, DiGiovanna MP, Pusztai L, Sanft T, et al. Impact of financial burden of cancer on survivors’ quality of life? J Oncol Pract. 2014;27:2014.

    Google Scholar 

  17. Dusetzina SB, Winn AN, Abel GA, Huskamp HA, Keating NL. Cost sharing and adherence to tyrosine kinase inhibitors for patients with chronic myeloid leukemia. J Clin Oncol Off J Am Soc Clin Oncol. 2014;32(4):306–11. This study showed that patients with higher copayments are more likely to discontiue or be nonadherent to Tyrosine Kinase Inhibitors.

    Article  Google Scholar 

  18. Young RA, DeVoe JE. Who will have health insurance in the future? An updated projection. Ann Fam Med. 2012;10(2):156–62.

    Article  PubMed Central  PubMed  Google Scholar 

  19. Guy 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. 2013;31(30):3749–57.

    Article  PubMed Central  PubMed  Google Scholar 

  20. Azzani M, Roslani AC, Su TT. The perceived cancer-related financial hardship among patients and their families: a systematic review. Support Care Cancer. 2015;23(3):889–98. This systematic review includes international studies and does an excellent job of summarizing the issues for patients and families, how financial hardship is manifested, and what can be done to predict and ameliorate financial toxicity.

    Article  PubMed  Google Scholar 

  21. Head BA, Faul AC. Development and validation of a scale to measure socioeconomic well-being in persons with cancer. J Support Oncol. 2008;6(4):183–92.

    PubMed  Google Scholar 

  22. de Souza JA, Yap BJ, Hlubocky FJ, Wroblewski K, Ratain MJ, Cella D, et al. The development of a financial toxicity patient-reported outcome in cancer: the COST measure. Cancer. 2014;120(20):3245–53.

    Article  PubMed  Google Scholar 

  23. Hwang W, Weller W, Ireys H, Anderson G. Out-of-pocket medical spending for care of chronic conditions. Health Aff (Millwood). 2001;20(6):267–78.

    Article  CAS  Google Scholar 

  24. Davidoff AJ, Erten M, Shaffer T, Shoemaker JS, Zuckerman IH, Pandya N, et al. Out-of-pocket health care expenditure burden for Medicare beneficiaries with cancer. Cancer. 2013;119(6):1257–65.

    Article  PubMed  Google Scholar 

  25. Palmer NR, Geiger AM, Lu L, Case LD, Weaver KE. Impact of rural residence on forgoing healthcare after cancer because of cost. Cancer Epidemiol Biomarkers Prev. 2013;22(10):1668–76.

    Article  PubMed  Google Scholar 

  26. REDBOOK Online [Internet Database]. Greenwood Village, Colo: Thomson Reuters (Healthcare) Inc. Updated periodically. Available from: http://sites.truvenhealth.com/redbook/online/. Accessed 2 Mar 2015

  27. 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. 2013;32(6):1143–52.

    Article  Google Scholar 

  28. Sharp L, Carsin A-E, 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.

    Article  PubMed  Google Scholar 

  29. 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.

    Article  PubMed Central  PubMed  Google Scholar 

  30. Berkowitz SA, Meigs JB, DeWalt D, Seligman HK, Barnard LS, Bright OJ, et al. Material need insecurities, control of diabetes mellitus, and use of health care resources: results of the measuring economic insecurity in diabetes study. JAMA Intern Med. 2015;175(2):257–65.

    Article  PubMed  Google Scholar 

  31. Abel GA, Albelda R, Salas Coronado DY, Marcellot L, Hahn T, Khera N, et al. Prospective assessment of familial financial hardship after hematopoietic cell transplantation. Biol Blood Marrow Transplant. 2015;21(2, Supplement):S72.

    Article  Google Scholar 

  32. Ward E, Halpern M, Schrag N, Cokkinides V, DeSantis C, Bandi P, et al. Association of insurance with cancer care utilization and outcomes. CA Cancer J Clin. 2008;58(1):9–31.

    Article  PubMed  Google Scholar 

  33. Pidala J, Craig BM, Lee SJ, Majhail N, Quinn G, Anasetti C. Practice variation in physician referral for allogeneic hematopoietic cell transplantation. Bone Marrow Transplant. 2013;48(1):63–7.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  34. Schrag D, Hanger M. Medical oncologists’ views on communicating with patients about chemotherapy costs: a pilot survey. J Clin Oncol Off J Am Soc Clin Oncol. 2007;25(2):233–7.

    Article  Google Scholar 

  35. Bullock AJ, Hofstatter EW, Yushak ML, Buss MK. Understanding patients’ attitudes toward communication about the cost of cancer care. J Oncol Pract. 2012. This study explores in depth the patients’ perspective on communicating with their physicians about the cost of cancer care, and showed that patients have a higher comfort level in discussing financial issues than their oncologists, with important implications for medical education.

  36. Alexander GC, Casalino LP, Tseng CW, McFadden D, Meltzer DO. Barriers to patient-physician communication about out-of-pocket costs. J Gen Intern Med. 2004;19(8):856–60.

    Article  PubMed Central  PubMed  Google Scholar 

  37. Kim W, McNulty J, Chang Y, Weise M, Hashmi S, Ailawadhi S, et al. Financial burden after allogeneic hematopoietic cell transplantation: a qualitative analysis from patient perspective. Bone Marrow Transplant. 2015.

  38. Alexander GC, Hall MA, Lantos JD. Rethinking professional ethics in the cost-sharing era. Am J Bioeth. 2006;6(4):W17–22.

    Article  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  40. Ubel PA, Abernethy AP, Zafar SY. Full disclosure — out-of-pocket costs as side effects. N Engl J Med. 2013;369(16):1484–6.

    Article  CAS  PubMed  Google Scholar 

  41. Barcellos SH, Wuppermann AC, Carman KG, Bauhoff S, McFadden DL, Kapteyn A, et al. Preparedness of Americans for the affordable care act. Proc Natl Acad Sci U S A. 2014;111(15):5497–502.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  42. Collins SR RP, Doty M, Beutel S. The rise in health care coverage and affordability since health reform took effect findings from the Commonwealth Fund Biennial Health Insurance Survey, 2015.

  43. Wharam JF, Ross-Degnan D, Rosenthal MB. The ACA and high-deductible insurance — strategies for sharpening a blunt instrument. N Engl J Med. 2013;369(16):1481–4.

    Article  CAS  PubMed  Google Scholar 

  44. Saloner B, Sabik L, Sommers BD. Pinching the poor? Medicaid cost sharing under the ACA. N Engl J Med. 2014;370(13):1177–80.

    Article  CAS  PubMed  Google Scholar 

  45. Malin JL. Wrestling with the high price of cancer care: should we control costs by individuals’ ability to pay or society’s willingness to pay? J Clin Oncol Off J Am Soc Clin Oncol. 2010;28(20):3212–4.

    Article  Google Scholar 

Download references

Compliance with Ethics Guidelines

Conflict of Interest

Julie McNulty declares no potential conflicts of interest.

Nandita Khera is a section editor for Current Hematologic Malignancy Reports.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Author information

Authors and Affiliations

  1. 500 N 3rd St, Phoenix, AZ, 85004, USA

    Julie McNulty

  2. 5777 E Mayo Blvd, Phoenix, AZ, 85054, USA

    Nandita Khera

Authors
  1. Julie McNulty
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Nandita Khera
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Julie McNulty.

Additional information

This article is part of the Topical Collection on Health Economics

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

McNulty, J., Khera, N. Financial Hardship—an Unwanted Consequence of Cancer Treatment. Curr Hematol Malig Rep 10, 205–212 (2015). https://doi.org/10.1007/s11899-015-0266-1

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11899-015-0266-1

Keywords

Search

Navigation