Individuals diagnosed with cancer in the United States often bear significant health-care costs and productivity losses, with over half incurring cancer-related medical debt. In response, cancer patients and survivors often delay or forgo necessary care; cut back on food, clothing, and basic household expenses; see their credit scores decrease; and in extreme cases, file bankruptcy.
In a new large study by the American Cancer Society (ACS), researchers found that people with cancer who live in counties with a higher share of residents having medical debt in collections were more likely to be diagnosed with cancer at a later stage and have worse survival. The report was published by Han et al in JNCCN—Journal of the National Comprehensive Cancer Network.
“Our findings are critically important, as residents of areas with high shares of medical debt could face multiple barriers to cancer screening and other preventive services, timely assessment of early signs of cancer, and effective cancer treatments after diagnosis, ultimately affecting cancer diagnosis and outcomes,” said lead study author Xuesong Han, PhD, Scientific Director, Health Services Research at the ACS. “There is a real need for policies and programs either directly preventing and reducing medical debt, or structurally promoting economic development and financial resilience in vulnerable communities to help increase access to affordable care and help people suffering from all types of disease.”
Study Details and Findings
In the study, researchers analyzed data from the National Cancer Database on adults aged 18 years and older who were newly diagnosed with cancer from 2011 to 2019. The county-level share of adults with medical debt in collections was combined with patient-level data. Scientists estimated associations of county-level medical debt with cancer diagnosis stage and overall survival, respectively, for all patients and by cancer type, clinical, and socioeconomic subgroups.
The results show a total of 7,558,658 individuals were identified with cancer, with a median county-level medical debt of 18%, ranging from 0% to 56%. The greatest proportion with a diagnosis of stage IV disease and the lowest 5-year survival rate were both seen in the counties having the highest medical debt. After adjusting for other patient- and county-level characteristics, patients living in counties with the highest medical debt were more likely to be diagnosed at stage IV and have poorer survival compared with those living in the lowest counties with medical debt. The pattern was observed among major cancer types and was consistent across subpopulations of different sociodemographic and clinical backgrounds.
“Future research is needed to evaluate ongoing policies, including those related to medical debt, large federal cuts to Medicaid and the social safety net, and expiration of Marketplace insurance subsidies, and their relationship with cancer care and outcomes,” Dr. Han added. “Studies including individual-level information on medical debt, health insurance coverage, and financial well-being and evaluating their impact throughout the cancer care continuum will be especially valuable for informing targeted and sustainable interventions to ensure everyone has equitable access to effective cancer prevention; screening; and early detection, treatment, and survivorship care.”
DISCLOSURE: For full disclosures of the study authors, visit jnccn.org.
