Disease- and Treatment-Related Risk Factors

Patients with advanced-stage cancers, cancers requiring chemotherapy or radiation therapy, and underlying comorbidities have a higher risk of financial hardship after diagnosis than those without these characteristics.[1-4] In a study of 1,556 cancer survivors identified from the 2010 National Health Interview Survey (NHIS) who responded to a single survey item assessing financial burden, survivors were more likely to report high financial burden if they received chemotherapy (47.2% vs. 30.8%; P < .001), received radiation therapy (44.7% vs. 31.4%; P < .001), and had recurrent or multiple cancers (40.9% vs. 33.7%; P < .049).[3]

A similar association was seen in an analysis using data from the 2008–2010 Medical Expenditures Panel Survey (MEPS) Household Component to measure loss of employment and productivity in individuals with and without cancer.[1] In this study, survivors with more-aggressive disease processes (i.e., recurrent, multiple, or poor-prognosis cancers) had the highest rates of lost productivity relative to individuals without cancer. Specifically, individuals with cancers associated with short survival were less likely to be employed (66.8% vs. 81.4%; P < .0001) and more likely to face limitations on their ability to participate in activities at home, work, or school (17.5% vs. 8.5%; P < .001) than individuals without cancer. Productivity among survivors of breast, prostate, colorectal, and other single cancers was not as decreased as productivity among those with higher-risk disease.

Another study used multiple years of the MEPS (2008‒2013) to evaluate the associations between cancer history, chronic conditions, and productivity losses.[5] Adult cancer survivors were significantly more likely to have chronic conditions, including heart disease, diabetes, asthma, and arthritis, than were adults without a cancer history. They were also more likely to have multiple chronic conditions. Cancer survivors who had multiple chronic conditions were more likely to be limited in their ability to work than cancer survivors without these other conditions. Among cancer survivors, those with four or more chronic conditions had annual productivity loss of $9,099 (95% confidence interval [CI], $7,224‒$10,973) compared with those without any additional chronic conditions (in 2013 dollars).

Receipt of cancer-directed treatment and the presence of other comorbidities were also found to be associated with higher out-of-pocket spending in the Medicare population. In a study using data from the Medicare Current Beneficiary Survey linked to Medicare claims (1997–2007), 2-year mean out-of-pocket spending was higher by $1,526 among patients receiving chemotherapy and by $1,470 among patients receiving radiation therapy compared with patients who did not receive treatment (P < .01).[6]

These studies suggest that cancer survivors across a broad age range with advanced cancers, recurrent cancers, or cancers that require treatment (likely a marker of more-advanced disease) are more likely to face higher out-of-pocket spending and are at higher risk of financial hardship. Chronic treatment-related spending in combination with inability to regain employment and income resulting from progressive disease and debility may contribute to the association between advanced disease and greater financial burden.