Exploring barriers to the receipt of necessary medical care among cancer survivors under age 65 years

• Type of Material: Article
• Authors: Matthew P. Banegas, Kaiser Permanente Center for Health Research; John F. Dickerson, Kaiser Permanente Center for Health Research; Erin E. Kent, National Cancer Institute; Janet S. de Moor, National Cancer Institute; Katherine Virgo, Emory University; Gery P. Guy, Jr., US Centers for Disease Control and Prevention; Donatus U. Ekwueme, US Centers for Disease Control and Prevention; Zhiyuan Zheng, American Cancer Society; Stephanie Nutt, University of Texas Austin; Loyce Pace, LIVESTRONG Foundation; Alexandra Varga, Kaiser Permanente Center for Health Research; Lisa Waiwaiole, Kaiser Permanente Center for Health Research; Jennifer Schneider, Kaiser Permanente Center for Health Research; Karen Yabroff, Emory University
• Language: English
• Date: 2018-02-01
• Publisher: SPRINGER
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2017, Springer Science+Business Media, LLC.
• Final Published Version (URL): http://dx.doi.org/10.1007/s11764-017-0640-1
• Title of Journal or Parent Work: JOURNAL OF CANCER SURVIVORSHIP
• Volume: 12
• Issue: 1
• Start Page: 28
• End Page: 37
• Keywords: Science & Technology; Oncology; FINANCIAL BURDEN; ECONOMIC BURDEN; COST; Access to care; financial hardship; ACCESS; EXPENDITURE BURDEN; Social Sciences, Biomedical; Medical debt; LOGISTIC-REGRESSION; Biomedical Social Sciences; Life Sciences & Biomedicine; RISK; Cancer survivors; Social Sciences; Disparities; HEALTH; UNITED-STATES; LONG-TERM
• Research Categories: Health Sciences, Oncology; Sociology, Public and Social Welfare

Abstract

Purpose: With increasing cancer care costs and greater patient cost-sharing in the USA, understanding access to medical care among cancer survivors is imperative. This study aims to identify financial, psychosocial, and cancer-related barriers to the receipt of medical care, tests, or treatments deemed necessary by the doctor or patient for cancer among cancer survivors age < 65 years. Methods: We used data on 4321 cancer survivors aged 18–64 years who completed the 2012 LIVESTRONG Survey. Multivariable logistic regression was used to identify risk factors associated with the receipt of necessary medical care, including sociodemographic, financial hardship, debt amount, caregiver status, and cancer-related variables. Results: Approximately 28% of cancer survivors were within 1 year, and 43% between 1 and 5 years, since their last treatment at the time of survey. Nearly 9% of cancer survivors reported not receiving necessary medical care. Compared to survivors without financial hardship, the likelihood of not receiving necessary medical care significantly increased as the amount of debt increased among those with financial hardship (RRFinancial hardship w/< $10,000 debt = 1.94, 95% CI 1.55–2.42, and RR RRFinancial hardship w/≥ $10,000 debt = 3.41, 95% CI 2.69–4.33, p < 0.001). Survivors who reported lack of a caregiver, being uninsured, and not receiving help understanding medical bills were significantly more likely to not receive necessary medical care. Conclusion: We identified key financial and insurance risk factors that may serve as significant barriers to the receipt of necessary medical care among cancer survivors age < 65 in the USA Implications for cancer survivors: The majority of cancer survivors reported receiving medical care either they or their doctors deemed necessary. However, identifying potentially modifiable barriers to receipt of necessary medical cancer care among cancer survivors age < 65 is imperative for developing interventions to ensure equitable access to care and reducing cancer disparities.