Abstract
Worldwide, around 18 million people receive a cancer diagnosis each year, most of whom survive long enough to face additional cancer-related costs. In France, most costs directly related to cancer are covered by the National Health Insurance Fund, and cancer patients can receive treatments without paying advance fees. In this context, the costs faced by cancer survivors are mostly social costs. Drawing on fundamental cause theory, this study aimed to explore the socially-differentiated evolution of cancer survivor’s income five years after diagnosis. Our study draws on the findings of VICAN5, a French national survey that was conducted in 2015/2016 in a representative sample of 4,174 cancer survivors to obtain information on living conditions five years after diagnosis, and that was restricted to 12 tumour sites accounting for 88% of global cancer incidence in France. We used the multiple imputation method and the Heckman selection model to identify the factors associated with a decrease in household income per consumption unit (HICU), while accounting for missing data. Among survivors still working five years after diagnosis, 17.6% reported lower income at survey than at diagnosis. After adjustment for socio-demographic and medical characteristics, the decrease in HICU was more frequent in women, singles, low educated survivors, and survivors with reduced working time. Finally, subjective measures of income variation and economic well-being were a useful complement to objective measures since 31.6% of cancer survivors still working five years after diagnosis reported a perceived decrease in household income. In conclusion, inequalities in economic well-being persist long after diagnosis in France, and this despite the fact that most cancer-related costs are covered by the French National Health Insurance Fund. Consequently, more attention should be paid to cancer patients with low socio-economic status to help reduce inequalities in post-diagnosis living conditions.
Highlights
In several countries, studies have found that cancer survivors are more likely than the general population to report financial difficulties [1,2,3]
Comparing respectively the group with decreased household income per consumption unit (HICU) and the group with increased HICU to the reference group, we found that cancer survivors with a HICU change were less educated than individuals without any change in HICU
Our three main findings are as follows: 1/ more than one in six cancer survivors still working five years after diagnosis (17.6%) reported a decrease in income; 2/ the decrease in HICU was greater in women than in men regardless of tumour site; and 3/ low socio-economic status was significantly associated with a decrease in HICU
Summary
Studies have found that cancer survivors are more likely than the general population to report financial difficulties [1,2,3]. Other studies have shown that low educational level is the factor most frequently associated with reduced earnings after a cancer diagnosis [2,6,15,16]. In light of these findings, we can presume that social vulnerability, defined as “the susceptibility of a community to the impact of hazards” [17], has a negative impact on cancer survivors, and in particular on their economic situation
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