Impact of functional disability on health-care use and medical costs among cancer survivors

Abstract

Background Cancer survivors with a disability are among the most vulnerable in health status and financial hardship, but no prior research has systematically examined how disability modifies healthcare use and costs. This study examines the association of functional disability among cancer survivors with their healthcare utilization and medical costs. Methods We generated nationally representative estimates using the 2015-2019 Medical Expenditure Panel Survey. Outcomes included utilization of six service types (inpatient, outpatient, office-based physician, office-based non-physician, ED, prescription) and medical costs of aggregate services and by each of six service types. Primary independent variable was a categorical variable of total number of functional disabilities. We employed multivariable generalized linear models and two-part models, adjusting for socio-demographics and health conditions and accounting for survey design. Results Among cancer survivors (n = 9,359; weighted n = 21,046,285), 38.8% reported at least one disability. Compared to those without disability, cancer survivors with ≥4 disabilities experienced longer hospital stays (adjusted average marginal effect [AME] 1.14 days; 95% confidence interval [CI] 0.55-1.73), more visits to office-based physician (AME 1.43 visits; 95% CI 0.51-2.35), and greater number of prescriptions (AME 12.1 prescriptions; 95% CI 9.27-15.0). Their total (AME $9,537; 95% CI $5,713-$13,361) and out-of-pocket (AME $639; 95% CI $79-$1,199) medical costs for aggregate services were significantly higher. By type, disability in independent living was most strongly associated with greater costs for aggregate services. Conclusions Cancer survivors with a disability experienced greater healthcare use and higher costs. Cancer survivorship planning for healthcare and financial stability should consider the patients’ disability profile.

Association of cancer diagnosis with disability status among older survivors of colorectal cancer: a population-based retrospective cohort study

“…Furthermore, our findings aligned with another study demonstrating that survivors of CRC exhibited a higher prevalence of disability compared to individuals without CRC (22). Given the substantial costs of disabilities (46) and their impact on quality of life, as well as potentially secondary effects (47), it is critical to identify cancer survivors at risk of developing Forest plot of hazard ratios and 95% confidence intervals for development of disability status in survivors of colorectal cancer.…”

“…Although our hazard ratio of 1.07 is small, the marginal rise in the risk of developing poor disability status provides valuable insights for clinical providers concerning the potential contribution of the CRC diagnosis among vulnerable older survivors of CRC. Recognizing the immense cost of disabilities (46) and their negative impact on quality of life, as well as future secondary effects (47) underscores the critical importance of identifying cancer survivors at risk of developing disability early, even at a small risk. This proactive approach can facilitate early rehabilitation, which has been shown to enhance clinical outcomes, mitigate the negative impact on health-related quality of life, and reduce the overall cost of disabilities (48,59,60).…”

Cancer diagnosis and treatment in working‐age adults: Implications for employment, health insurance coverage, and financial hardship in the United States

“…This validated composite measure is based on six questions about the difficulties people may have because of health problems (i.e., difficulty seeing, hearing, walking or climbing steps, remembering or concentrating, self‐care, and communicating) 58 . Among cancer survivors, having a disability is associated with higher prevalence of financial hardship compared with those without a disability (Figure 8), consistent with findings reported elsewhere 59 Emily lives in Texas, a state without any provisions for disability insurance wage replacement.…”

“…Among cancer survivors, having a disability is associated with higher prevalence of financial hardship compared with those without a disability (Figure 8), consistent with findings reported elsewhere. 59 Emily lives in Texas, a state without any provisions for disability insurance wage replacement. She can apply for federal disability benefits, but the process may take anywhere from 3 months to several years.…”