Although advances in cancer treatments have led to huge increases in the number of survivors in the United States—more than 16.9 million in 2019—many of those survivors, particularly those aged 18 to 64, face substantial medical financial hardship due to their diagnosis and treatment, necessitating sacrifices in spending, savings, or their living situation, according to a study by Han et al published in Cancer Epidemiology, Biomarkers, and Prevention. Extended employment change, health insurance costs, and comorbidities were all associated with intensity of medical financial hardship and financial sacrifices.

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Study Methodology

The researchers identified 963 cancer survivors from the 2016 Medical Expenditure Panel Survey, a nationally representative survey that collected information on health insurance coverage, health-care utilization and expenditures, and health conditions. They measured medical financial hardship due to cancer based on the participants’ survey answers. The survey included questions about the effects of cancer; its treatment; and the lasting effects of the treatment on finances, health insurance, and employment.

The researchers characterized medical financial hardship into three domains:

• Material, including whether the survivors had to borrow money or go into debt, were able to cover their share of cancer care cost, and had to file for bankruptcy
• Psychological, such as worry over large medical bills
• Behavioral, including whether the survivors had to delay, forgo, or make other changes to their cancer care because of cost.

Multivariable logistic models were used to identify characteristics associated with hardship intensity and sacrifices stratified by age group, either age 18 to 64 or 65 years and older.

Study Findings

The researchers found that among cancer survivors aged 18 to 64, 53.6%, 28.4%, and 11.4% reported at least one, two, or all three domains of hardship, respectively. Among survivors aged 65 and older, corresponding percentages were 42%, 12.7%, and 4%. In addition, financial sacrifices due to cancer were more common in survivors aged 18 to 64 (54.2%) than in survivors aged 65 and over (38.4%; P < .001).

The factors that were significantly associated with hardship intensity included low income and educational attainment, racial/ethnic minority, comorbidity, lack of private insurance coverage, extended employment change, and recent cancer treatment. Most were also significantly associated with financial sacrifices.

“Medical financial hardship and financial sacrifices are substantial among cancer survivors in the United States, particularly for younger survivors. Efforts to mitigate financial hardship for cancer survivors are warranted, especially for those at high risk,” concluded the study researchers.

Finding Solutions to Prevent Financial Toxicity

Studies show that cancer survivors experiencing severe financial distress requiring bankruptcy protection have a higher mortality risk. Financial interventions—including patient financial navigation and patient assistance programs, physician-patient communication regarding cancer care costs, improved employer accommodation, and state and federal policy ensuring affordable health insurance for cancer survivors—can help prevent cancer-related financial hardship among survivors and their families, according to the study authors.

“Overall, health insurance coverage is critically important for cancer patients and survivors,” said lead study author Xuesong Han, PhD, Senior Principal Scientist in Health Services Research at the American Cancer Society, in a statement. “Even those who had private insurance coverage reported financial hardship, suggesting that the types of coverage and extent of patient cost-sharing are important too. Provisions of the Affordable Care Act that have expanded insurance coverage options, such as the Medicaid expansion, have been associated with reductions in financial hardship among cancer survivors in other studies. Employers can play a large role in mitigating hardship through flexible workplace accommodations, such as availability of paid and unpaid sick leave, and supportive programs for both survivors and family members.”

Dr. Han is the corresponding author of this study.

Disclosure: For full disclosures of the study authors, visit cebp.aacrjournals.org.