The Association Between Physical Functioning and Healthcare Utilization Among Cancer Survivors

Abstract

Previous studies have demonstrated financial strain among cancer survivors, partly mediated by healthcare expenditures due to the increased care cancer survivors require. Healthcare expenditures among adults aged ≥ 70 years are also associated with lower physical functioning as well as increased total medical visits. However, no study to-date has examined the association between physical functioning, healthcare expenditures, and total medical visits among adult cancer survivors of all ages. Thus, we sought to assess this relationship. Data on a number of health indicators are collected in noninstitutionalized civilian adults by the U.S. Medical Expenditure Panel Survey. For this study, harmonized data of participants reporting a cancer diagnosis were extracted from the Integrated Health Interview Series from 2007-2017. The Physical Component Score (PCS) is a validated measure of physical functioning ranging in score from 0 to 100 points, higher scores representing better health. Data was collected on counts of visits in several treatments settings as proxy for healthcare utilization such as inpatient, outpatient, emergency department, home health services, and “other” medical visits. Medical expenditure data was also collected that included all medical payments for such visits. Multivariable logistic regression defined adjusted odds ratios (AOR) with 95% confidence intervals (95CI) for healthcare utilization as dependent variable and PCS as an independent variable of interest. A separate model was also run for total medical expenditure as the dependent variable and PCS as an independent variable. Among 290,700 participants, adult cancer survivors were less likely to be in the top quartiles (Q3, Q4) of PCS scores relative to adults without cancer (20.33% vs 47.15%, AOR 0.78, 95CI 0.70-0.87, P<0.001). Having cancer was also associated with increased medical expenditures (median $4,845 vs $500, AOR 3.02, 95CI 2.53-3.61, P<0.001) and increased medical visits (median 0 [IQR 0, 1] vs. 0 [IQR 0, 3] visits, AOR 1.62, 95CI 1.51-1.74, P<0.001). Among 45,975 adult cancer survivors, those in Q1 of PCS score (lowest PCS score and worst physical functioning) had the highest medical expenditures relative to other quartiles (median $7,594 Q1; $3,256 Q2; $2,113 Q3; $2,181 Q4). Furthermore, adult cancer survivors in Q1 were more likely to have the highest medical visits (median visits: Q1 [referent], 1 [IQR 0, 6]; Q2, 0 [IQR 0, 2], AOR 0.67, 95CI 0.60-0.75, P<0.001; Q3, 0 [0, 1] AOR 0.50, 95CI 0.42-0.60, P<0.001; Q4, 0 [IQR 0, 1] AOR 0.43, 95CI 0.35-0.51, P<0.001). Lower physical functioning is associated with increased medical expenditure, medical visits and increase in healthcare utilization in cancer survivors. Lower physical functioning has been shown to predict higher mortality and morbidity. Our results show the need for improving physical functioning in cancer survivors which may mitigate the high healthcare costs incurred by this population.