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Challenges receiving, affording health care persist among cancer survivors
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Cancer survivors faced greater difficulties affording and accessing health care than individuals with no cancer history, even with insurance coverage rates increasing under the Affordable Care Act, according to results of a population-based study published in JAMA Oncology.
“Despite cancer survivors’ need for long-term access to high-quality and affordable health care, this population is at particularly high risk for experiencing financial burden related to the high costs of their care, which may negatively influence their ability to receive necessary survivorship care,” Ryan D. Nipp, MD, MPH, gastrointestinal oncologist and health services researcher at Massachusetts General Hospital, and colleagues wrote. “Growing evidence demonstrates that patients with cancer experience substantial economic hardship related to their care, yet barriers to accessing and affording care experienced by cancer survivors remain understudied.”
The researchers used 2010 to 2016 data from the National Health Interview Survey to evaluate 30,364 participants aged at least 18 years (57.4% women; mean age, 63.5 years) who were cancer survivors (n = 15,182) or who had no cancer history (controls, n = 15,182). Researchers excluded patients who reported having a cancer diagnosis in childhood or who had nonmelanoma skin cancers.
Differences in issues with accessing health care — such as forgoing or delaying care — and affordability between cancer survivors and controls served as the main outcomes. The researchers also examined temporal trends among survivors who reported difficulties with affordability or access.
Respondents who had survived cancer appeared more likely to have health insurance than controls (94.8% vs. 92.2%; P < .001) or be insured by the government (44.3% vs. 38.8%; P < .001).
However, multivariable models showed cancer survivors appeared more likely to report delayed care (OR = 1.38; 95% CI, 1.16-1.63), forgoing medical care (OR = 1.76; 95% CI, 1.45-2.12) and/or problems affording medications (OR = 1.77; 95% CI, 1.46-2.14). Cancer survivors also appeared more likely to report difficulties affording health care services (OR = 1.46; 95% CI, 1.27-1.68).
The proportion of survivors who reported delayed medical care fell 0.47 percentage points each year from 2010 to 2016 (P = .047), and the proportion of those who reported needing and not receiving medical care decreased by 0.35 percentage points per year (P = .04).
The proportion of survivors who could not afford prescription medication fell 0.66 percentage points each year (P = .004), and the proportion of those who could not afford at least one of six different categories of medical services fell 0.51 percentage points each year (P = .01).
“Our results provide important evidence during this time of change as debate over health care reform continues,” the researchers wrote. “With the growing number of cancer survivors and the rising costs of health care in the United States, future efforts to enhance access to affordable health care should build on our findings and focus on improving our understanding of specific financial barriers, consequences of these barriers and opportunities to screen for and address patients’ financial burden and barriers to care.” – by Andy Polhamus
Disclosures: The authors report no relevant financial disclosures.
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