Patient Characteristics Hint at Financial Sensitivity to Cancer Care

Norman Carroll, PhD

A study published recently in the journal Cancer offers help to physicians in recognizing which of their patients would experience heightened sensitivity to the financial strain of cancer care.

The study looked at Medical Expenditure Panel Survey data from 2011 involving 19.6 million cancer survivors, finding that nearly 29% of them were financially burdened as a result of their cancer diagnosis and/or treatment.²

“Our results suggest that policies and practices that minimize cancer patients’ out-of-pocket costs can improve survivors’ health-related quality of life and psychological health,” said study co-author Norman Carroll, PhD, of Virginia Commonwealth University (VCU) School of Pharmacy. “Reducing the financial burden of cancer care requires integrated efforts, and the study findings are useful for survivorship care programs, oncologists, payers, pharmaceutical companies, and patients and their family members.”

The study found what it described as significant differences between cancer survivors (CS) with financial burden versus those without. Significant predictors of financial burden included being younger at diagnosis, being female, being a member of a racial/ethnic minority group, lacking access to health insurance, being currently treated, being diagnosed between 1 and < 3 years previously, and having a short-survival cancer.

1. Has anyone in their family had to borrow money or go into debt?
2. Have they made any other financial sacrifices?

1. Have they ever worried about paying large medical bills?
2. Have they been unable to cover the cost of medical care visits?

Of those included in the study, 7.6% borrowed money, incurred debt, or declared bankruptcy. Among the borrowers, 4.2% borrowed < $10,000; 3% borrowed ≥ $10,000; and 1.4% declared bankruptcy. Approximately 20.9% were worried about paying large medical bills; 11.5% were unable to cover the cost of medical care visits; and 8.6% made other financial sacrifices. Approximately 71.3% of the group reported no financial problems. Among the 29% with financial difficulty, 15.8% reported 1 financial problem; 7.2% reported 2; 4.1% reported 3; and 1.5% incurred all four financial problems.

Study co-author Hrishikesh Kale, MS, said that in order to mitigate the costs and burden of treatment, “oncologists should consider selecting treatments that are less expensive but similar in effectiveness, discuss treatment costs with patients, and involve patients in making decisions about their therapy.”

The study recommended that oncologists would be helped in treatment choice decisions by a value framework similar to the drug valuation model ASCO introduced late last year.2 It stated that future research should evaluate the role of value-based reimbursement, clinical practice guidelines, and physician-patient communication regarding reducing the cost of cancer care.

The authors also said there is a big role for cancer patients and family members in the form of self-education on survivor issues, coverage and benefit design of their health plans, and organizations that provide financial assistance. “Cancer survivorship care programs can identify survivors with the greatest financial burden and focus on helping them cope with psychological stress, anxiety, and depression throughout their journey with cancer,” Kale said.

Part of the study was devoted to an assessment of the physical component scores (PCS) and mental component scores (MCS) of the patient group under analysis in order to determine any relationship between scores on those profiles and financial burden. At the outset of doing the study, however, the researchers hypothesized that there would be a direct relationship between low PCS and MCS scores and financial burden. Their findings proved them correct.

“We found that financial burden had a significant linear association with PCS and MCS. Furthermore, survivors with ≥ 3 financial problems were found to have significantly lower PCS and MCS compared with survivors without financial problems,” the authors wrote. For example, the odds for depressed mood were 3.41 times higher and for psychological distress were 2.56 times higher for survivors reporting ≥ 3 financial problems than for those without financial problems, the authors said.

Those with financial distress worried more often about cancer recurrence (69% vs 35%) and cancer recurrence affecting their responsibilities (70% vs 38%). They also perceived a greater likelihood of cancer recurring or getting worse within the next 10 years (45% vs 24%). Similarly, odds for worrying about cancer recurrence increased with the number of financial problems, the authors wrote.

Of all CS in the analysis, 21% worried about paying large medical bills, 11.5% were unable to cover the cost of medical care visits, 7.6% reported borrowing money or going into debt, 1.5% declared bankruptcy, and 8.6% reported other financial sacrifices.

“Cancer survivors who faced such financial difficulties had lower physical and mental health-related quality of life, higher risk for depressed mood and psychological distress, and were more likely to worry about cancer recurrence compared with cancer survivors who did not face financial problems,” the study said.

CS who reported bankruptcy or having had to borrow money corresponded to 1.5 million members of the study population, and those individuals reported the worse physical and mental health related quality of life (HRQOL).

The majority of those in the study were diagnosed before age 65, female, non-Hispanic white, married, and had ≥ 3 noncancer chronic health conditions. Most had access to health insurance during the course of cancer care. A total of 17% of the CS had breast cancer, 12% had prostate cancer, and 58% had miscellaneous cancers.

References

1. Kale H, Carroll NV. Self-reported financial burden of cancer care and its effect on physical and mental health-related quality of life among US cancer survivors. Cancer. 2016. doi: 10.1002/cncr.29808. Accessed March 18, 2016.
2. ASCO drafts value framework to assist patient-physician conversations [news release]. Alexandria, VA: ASCO; October 9, 2015. http://pallonc.org/asco-drafts-value-framework-assist-patient%E2%80%93physician-conversationhttp://pallonc.org/asco-drafts-value-framework-assist-patient%E2%80%93physician-conversations. Accessed March 18, 2016.