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.
Highlights
Many cancer survivors face serious financial burdens related to cancer.[1]
There is no single definition of financial burden, the concept of “financial toxicity” commonly includes both objective financial burdens experienced by cancer patients and survivors, and subjective financial distress related to the cost of cancer treatment.[2]
The Life and Longevity After Cancer (LILAC) cancer survivorship cohort was designed with three study objectives: (a) to collect treatment and outcomes information from women diagnosed with cancer during their participation in Women’s Health Initiative (WHI); (b) to supplement the WHI biorepository with tissue samples from select solid tumors; and (c) to test the ability of electronic administrative data to produce reliable treatment and recurrence data.[21]
Summary
Many cancer survivors face serious financial burdens related to cancer.[1]. there is no single definition of financial burden, the concept of “financial toxicity” commonly includes both objective financial burdens experienced by cancer patients and survivors, and subjective financial distress related to the cost of cancer treatment.[2]Prevalence of financial burden varies depending on the population and the types of financial burden included;[3] studies commonly report a prevalence of financial burden of 30%-50%.4,5 These burdens can include out-of-pocket costs and missed work days immediately surrounding diagnosis and treatment, but can continue for years afterward.[6-8]. Prevalence of financial burden varies depending on the population and the types of financial burden included;[3] studies commonly report a prevalence of financial burden of 30%-50%.4,5 These burdens can include out-of-pocket costs and missed work days immediately surrounding diagnosis and treatment, but can continue for years afterward.[6-8]. Having health insurance does not prevent survivors from experiencing cancer-related financial burdens,18—a cancer diagnosis can lead to changes in insurance status, increases in insurance premiums,[10] and the inability to obtain or keep health or life insurance.[19]. Methods: We 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. Cancer site, social support, receipt of radiation, and receipt of hormone therapy were not associated with
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