Obesity linked to ‘substantial economic burden’ among long-term cancer survivors
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Obesity among long-term cancer survivors appeared associated with substantial excess medical spending, reaching $19.7 billion in 2016, according to a study in Cancer.
The American Cancer Society study provided the first national estimate of economic burden linked to obesity among long-term cancer survivors in the U.S., researchers wrote.
“With increasing prevalence of cancer survivorship and high costs of cancer, the economic burden associated with cancer is increasing. Prevention — including promotion of healthy lifestyles such as maintaining a healthy body weight — can be a cost-effective strategy in reducing economic burden of cancer,” Xuesong Han, PhD, epidemiologist and health services researcher in the department of surveillance and health equity science at American Cancer Society, told Healio. “However, the economic burden of obesity hadn’t been estimated for cancer survivors. This knowledge gap motivated us to conduct the study using a nationally representative sample to provide such estimation.”
Han and colleagues used a two-part modeling approach to compare annual care utilization and spending by service type among normal-weight long-term cancer survivors vs. those who had overweight or obesity.
The analysis included 12,547 long-term adult cancer survivors (58.4% men; 75.9% aged 55 years or older; 83.6% non-Hispanic white) at least 2 years removed from diagnosis who participated in the 2008-2016 nationally representative Medical Expenditure Panel Survey. Body weight categories included normal weight (BMI, 18.5 kg/m2 to < 25 kg/m2), overweight (BMI, 25 kg/m2 to < 30 kg/m2), obesity (BMI, 30 kg/m2) and severe obesity (BMI, 40 kg/m2). Researchers excluded individuals defined as underweight (BMI, < 18.5 kg/m2) and survivors of nonmelanoma skin cancer.
Results showed, when compared with normal-weight survivors, survivors with obesity had an additional $3,216 (95% CI, 1,940-4,492) in annual medical spending, including an excess $1,243 (95% CI, 417-2,070) on hospital impatient services and $1,130 (95% CI, 756-1,504) on prescriptions per person per year. Additionally, researchers reported magnified effects among survivors with severe obesity, who had excess total medical spending of $5,317 (95% CI, 2,849-7,785) per person per year, with $1,897 in excess hospital impatient spending (95% CI, 584-3,209) and $1,979 (95% CI, 1,284-2,673) in excess prescription spending.
Survivors with overweight had generally similar care utilization and medical spending as those with normal weight.
“Obesity is associated with substantial economic burden among long-term cancer survivors in the U.S.,” Han said. “Policies and practices promoting a healthy lifestyle and achieving and maintaining a healthy body weight for cancer survivors may reduce health care utilization and economic burden.”
Han said the findings mostly fell in line with researchers’ expectations.
“One surprise was that unlike the general population, where overweight individuals also have higher care utilization and medical spending than those with normal weight, we found that among long-term cancer survivors, care utilization and medical spending are generally comparable between overweight and normal weight survivors,” Han told Healio. “The underlying reasons for this observation warrant further investigation.”
Comorbid conditions related to obesity — such as diabetes, arthritis and heart diseases — as well as poorer quality of life “mostly explained” the excess care utilization and medical spending, Han and colleagues wrote.
Among the study cohort, 31.1% had obesity (including 4.9% with severe obesity), 36.3% had overweight and 32.6% fell into the normal-weight category. Moreover, from 2008 to 2016, the proportion of survivors with obesity increased from 27.4% to 34% and the proportion with severe obesity increased from 3.9% to 7%.
The association of obesity with out-of-pocket cost burden and financial hardship in this population warrants further research, as does the effectiveness of possible interventions the health care community could consider in addressing obesity among patients, according to Han.
“Members of the cancer care community, health care providers and other interested parties can promote a healthier lifestyle for cancer survivors,” Han told Healio. “As we discuss in the paper, despite its well-known health benefits and potentially sizable economic benefits, losing weight and maintaining a normal weight can be challenging without professional help. Health insurance coverage for weight management services, such as obesity screening and counseling and some bariatric surgical procedures, may play a role in ensuring access to medical assistance for achieving and maintaining a normal weight.
“Policy interventions — such as provisions of the Affordable Care Act removing cost-sharing for recommended preventive services including obesity screening and nutrition and physical activity counseling for high-risk adults — could help,” she added. “In clinical settings, including obesity assessment and management in oncology practice and increasing provider referrals to weight management services can help ,too. Moreover, since obesity is associated with other chronic conditions such as heart disease and diabetes, incorporating weight management into care coordination and multimorbidity management for cancer survivors may effectively reduce health care costs, in addition to other health benefits.”
For more information:
Xuesong Han, PhD, can be reached at American Cancer Society, 250 Williams St. NW, Atlanta, GA 30303; email: xuesong.han@cancer.org.
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