Healthcare Expenditure Burden Among Non-elderly Cancer Survivors, 2008-2012

• Type of Material: Article
• Authors: Gery P. Guy Jr., Centers for Disease Control and Prevention; K. Robin Yabroff, National Cancer Institute; Donatus U. Ekwueme, Centers for Disease Control and Prevention; Katherine S Virgo, Emory University; Xuesong Han, Emory University; Matthew P. Banegas, Kaiser Permanente Northwest; Anita Soni, Center for Financing, Access, and Cost Trend; Zhiyuan Zheng, American Cancer Society; Neetu Chawla, Kaiser Permanente Northern California; Ann M. Geiger, National Cancer Institute
• Language: English
• Date: 2015-12-01
• Publisher: Elsevier: 12 months
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2018 Elsevier Inc. All rights reserved.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.amepre.2015.09.002
• Title of Journal or Parent Work: American Journal of Preventive Medicine
• ISSN: 0749-3797
• Volume: 49
• Issue: 6
• Start Page: S489
• End Page: S497
• Grant/Funding Information: Publication of this article was supported by the Centers for Disease Control and Prevention, Division of Cancer Prevention and Control.
• Keywords: UNITED-STATES; THERAPY; Public, Environmental & Occupational Health; Medicine, General & Internal; General & Internal Medicine; MEDICAL-CARE; ONCOLOGISTS; Life Sciences & Biomedicine; MAMMOGRAPHY; BREAST-CANCER; ADULTS; COST; 2ND PRIMARY CANCERS; Science & Technology; NATIONAL-SURVEY
• Research Categories: Health Sciences, Oncology; Health Sciences, Public Health

Abstract

Introduction There is increasing concern regarding the financial burden of cancer on patients and their families. This study presents nationally representative estimates of annual out-of-pocket (OOP) burden among non-elderly cancer survivors and assesses the association between high OOP burden and access to care and preventive service utilization. Methods Using the 2008-2012 Medical Expenditure Panel Survey, 4,271 cancer survivors and 96,780 individuals without a history of cancer were identified, all aged 18-64 years. High annual OOP burden was defined as spending >20% of annual family income on OOP healthcare costs. Associations between high OOP burden and access to care were evaluated with multivariable logistic regression. Analyses were conducted in 2015. Results Compared with individuals without a cancer history, cancer survivors were more likely to report a high OOP burden (4.3% vs 3.4%, p=0.009) in adjusted analyses. High OOP burden was more common among cancer survivors who were poor (18.4%), with either public insurance (7.9%) or uninsured (5.7%), and not working (10.2%). Among cancer survivors, high OOP burden was associated with being unable to obtain necessary medical care (19.2% vs 12.5%, p=0.002), delaying necessary medical care (21.6% vs 13.8%, p=0.002), and lower breast cancer screening rates among age-appropriate women (63.2% vs 75.9%, p=0.02). Conclusions High OOP burden is more common among adults with a cancer history than those without a cancer history. High OOP burden was associated with being unable to obtain necessary medical care, delaying necessary medical care, and lower breast cancer screening rates among women.