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Costs force many young cancer survivors to skip medical care
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Adolescents and young adults who survived cancer are more likely to forgo health care due to costs than those with no cancer history, according to study results.
That lack of health care reduces the number of opportunities for clinicians to detect adverse late effects related to treatment, researchers said.
More than 69,000 adolescents and young adults (AYA), defined as those aged 15 to 39 years, are diagnosed with cancer each year in the United States. Approximately 80% of AYAs with cancer survive at least 5 years after diagnosis, but many are at risk for developing health problems related to chemotherapy, radiation and/or surgery they underwent during treatment.
AYA patients also often are financially vulnerable and their insurance coverage may be unstable, the researchers said.
In the study, Anne C. Kirchhoff, PhD, MPH, assistant director in the department of pediatrics for the Huntsman Cancer Institute at the University of Utah, and colleagues analyzed data provided by AYAs who responded to the 2009 Behavioral Risk Factor Surveillance System survey.
Kirchhoff and colleagues evaluated responses from 2,056 participants with a self-reported history of cancer. Another 67,216 patients who reported no cancer history served as controls.
Of the 2,056 participants with a self-reported cancer history, 979 met eligibility criteria (age 15 to 34 years, and 5 years post-diagnosis).
The percentage of those who indicated they were uninsured was similar in both arms (21% for those with cancer history vs. 23% for controls; RR=1.67; 95% CI, 1.44-1.94).
However, uninsured AYAs with a history of cancer were significantly more likely to skip routine medical care due to costs, study results showed.
Seventy-six percent of uninsured AYA cancer survivors reported avoiding medical care in the previous year for financial reasons compared with 48% of those in the control group (P<.001).
Among all AYA cancer survivors, 44% of those aged 20 to 29 years and 26% of those aged 30 to 39 years reported avoiding medical care in the prior year due to cost, compared with 16% of controls in each age bracket (P<.001).
Researchers also stratified the data by sex. They determined 22% of male cancer survivors avoided care due to costs compared with 12% of controls. Thirty-five percent of female cancer survivors avoided care due to cost compared with 18% of controls, a statistically significant difference (P<.001).
The findings suggest AYA cancer survivors need support beyond health insurance, the researchers said. That support could include information about community health centers and financial assistance programs, as well as education about the long-term health risks associated with cancer.
“Given the need to monitor AYA cancer survivors for recurrence and late effects of treatment, increasing the access to health care for this population is of public health importance,” Kirchhoff and colleagues concluded. “Although AYA survivors should be educated about their health risks following cancer treatment, expanding health insurance coverage for young survivors may prove insufficient to increasing their health care access without adequate strategies to reduce their medical cost burdens.”
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Harry S. Jacob, MD, FRCPath(Hon)
How ironic — and immoral — that we spend tens of thousands of dollars to cure a cancer patient and then leave many of them without medical insurance because of their “previous medical condition.” Perhaps this should be rectified — duh.
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