Medical Financial Hardship Intensity and Financial Sacrifice Associated with Cancer in the United States

Abstract

Background: With rising costs of cancer care, this study aims to estimate the prevalence of, and factors associated with, medical financial hardship intensity and financial sacrifices due to cancer in the United States.

Methods: We identified 963 cancer survivors from the 2016 Medical Expenditures Panel Survey - Experiences with Cancer. Medical financial hardship due to cancer was measured in material (e.g., filed for bankruptcy), psychological (e.g., worry about paying bills and finances), and behavioral (e.g., delaying or forgoing care due to cost) domains. Nonmedical financial sacrifices included changes in spending and use of savings. Multivariable logistic models were used to identify characteristics associated with hardship intensity and sacrifices stratified by age group (18-64 or 65+ years).

Results: Among cancer survivors ages 18 to 64 years, 53.6%, 28.4%, and 11.4% reported at least one, two, or all three domains of hardship, respectively. Among survivors ages 65+ years, corresponding percentages were 42.0%, 12.7%, and 4.0%, respectively. Moreover, financial sacrifices due to cancer were more common in survivors ages 18 to 64 years (54.2%) than in survivors 65+ years (38.4%; P < 0.001). Factors significantly associated with hardship intensity in multivariable analyses included low income and educational attainment, racial/ethnic minority, comorbidity, lack of private insurance coverage, extended employment change, and recent cancer treatment. Most were also significantly associated with financial sacrifices.

Conclusions: Medical financial hardship and financial sacrifices are substantial among cancer survivors in the United States, particularly for younger survivors.

Impact: Efforts to mitigate financial hardship for cancer survivors are warranted, especially for those at high risk.

Figure 1.

Medical financial hardship associated with cancer by age group, unadjusted (N=963) Weighted percentages of reporting none, one, two, and all three domains of material, psychological, and behavioral medical financial hardship in cancer survivors, by age group. Data are from the Medical Expenditure Panel Survey, 2016.

Figure 2.

Financial sacrifice associated with cancer by age group, unadjusted (N=963) (A) Weighted percentages of individuals reporting any financial sacrifice; (B) Percentages of individuals reporting separate measures of financial sacrifice. Data are from the Medical Expenditure Panel Survey, 2016. Chi-square tests were used to compare between the two age groups and calculate the p-values. Any financial sacrifices were defined as having responded yes to one or more of the individual financial sacrifice measures including reduce spending on vacation or leisure activities, delay large purchases, reduce basic spending, use savings set aside for other purposes, make a change to living situation, and/or other sacrifice because of cancer.