Financial burden among older, long‐term cancer survivors: Results from the LILAC study

Abstract

BackgroundIncreasing attention is being paid to financial burdens of cancer survivorship, but little is known about the prevalence and predictors of these burdens in older, long‐term survivors.MethodsWe used data from 6012 participants diagnosed with cancer since enrolling in the Women's Health Initiative, and who participated in the Life and Longevity After Cancer (LILAC) ancillary study to estimate prevalence and identify predictors of financial burden. We used logistic regression to identify sociodemographic, socioeconomic, health‐ and cancer‐related factors associated with financial burden and backward selection to build a final multivariable model.ResultsAverage age at LILAC participation was 79 and 9.2 years had elapsed since cancer diagnosis. Overall, 6% experienced some form of financial burden, including having an insurance company refuse a claim (2.6%), being denied loans or insurance due to cancer history (2.2%), or experiencing significant indebtedness (1.8%, including facing large debts or bills or declaring bankruptcy). Eight predictors remained associated (P < 0.05) with financial burden in the fully‐adjusted model: younger age, shorter time since diagnosis, African‐American race, household income <$20 000/year, modified Charlson comorbidity score ≥2, receipt of chemotherapy, regional stage at diagnosis, and no private health insurance. Education, cancer site, social support, receipt of radiation, and receipt of hormone therapy were not associated with financial burden. Predictors differed between types of financial burden experienced and age at diagnosis (<65 vs 65+).ConclusionCancer‐related financial burden was rare in this population of older, female long‐term cancer survivors. The identification of several socioeconomic, health‐related and demographic predictors of financial burden may suggest targets of intervention to reduce financial burdens.PrecisFinancial burden was uncommon in older, female, long‐term survivors. Predictors of financial burden included age, race, income, comorbidities, time since diagnosis, stage, insurance, and receipt of chemotherapy.

Financial Toxicity After Acute Respiratory Distress Syndrome: A National Qualitative Cohort Study*

“…Much research on financial toxicity has focused on patients with cancer; it demonstrated that patients report significant financial burdens from out-of-pocket expenses, particularly from drug therapies and ambulatory care. (26,27) Our data suggest financially toxic expenses can result from lengthy hospitalizations and rehabilitation. Our findings offer an important qualitative supplement to studies of financial burden among survivors of critical illness (5,10,18) and emphasize the need to examine how financial toxicity may differ between patients with cancer and patients with other illness.…”

Race, financial hardship, and limiting care due to cost in a diverse cohort of cancer survivors

“…Our finding that experiencing financial hardship is associated with limiting care due to cost is consistent with previous findings that financial problems were associated with forgoing or delaying medical care, [8] and especially with nonadherence to prescription medications, [13] including oral oncolytics. [13]- [16] While several previous studies have reported higher prevalence of financial hardship among non-white compared with white cancer survivors, [3], [8], [18], [20], [21] less is known about how specific types of financial hardship differ by race. Similar to our findings, in a longitudinal study of breast cancer survivors, Jagsi et al reported that more white (90%) than African American (81%; p<0.001) survivors used income and/or savings to pay for cancer care, while more African American (15%) than white (9%; p=0.03) survivors faced cancer-related debt.…”

“…[1], [12] Cancer survivors are more likely than adults with no history of cancer to forgo several types of care, including medical, dental, and mental health care and prescription medications, [7] Financial problems are associated with forgoing cancer care due to cost, [8], [13] specifically, high out-of-pocket costs and other financial strains are associated with nonadherence to prescription medications among cancer patients and survivors, [13]- [16] and with not receiving recommended surveillance after a cancer diagnosis. [17] There is evidence that financial hardship is most common among racial/ethnic minority and low-income survivors; [3], [8], [18]- [21] however, less is known about whether the types of financial hardship experienced differ by race. [3], [22] Additionally, previous work has not established whether the association between financial hardship and limiting care due to cost varies by type of financial hardship.…”

The relationships of unmet needs with quality of life and characteristics of Indonesian gynecologic cancer survivors

“…This finding reflects financial toxicity, that is, the financial hardship and the subjective financial distress due to cancer and its treatment cost (Ratain, 2009;Yabroff et al, 2004). There is a growing concern about financial toxicity as a serious burden for the cancer survivors, especially in the United States where the treatment costs, including the out of pocket (OOP) costs, are increasing (Altice et al, 2017;Hastert et al, 2018;Yabroff et al, 2004). Study regarding financial toxicity in Indonesia is very limited.…”