Financial Hardship Associated With Cancer in the United States: Findings From a Population-Based Sample of Adult Cancer Survivors

To estimate the prevalence of financial hardship associated with cancer in the United States and identify characteristics of cancer survivors associated with financial hardship. We identified 1,202 adult cancer survivors diagnosed or treated at ≥ 18 years of age from the 2011 Medical Expenditure Pan...

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Vydáno v:	Journal of clinical oncology Ročník 34; číslo 3; s. 259 - 267
Hlavní autoři:	Yabroff, K Robin, Dowling, Emily C, Guy, Jr, Gery P, Banegas, Matthew P, Davidoff, Amy, Han, Xuesong, Virgo, Katherine S, McNeel, Timothy S, Chawla, Neetu, Blanch-Hartigan, Danielle, Kent, Erin E, Li, Chunyu, Rodriguez, Juan L, de Moor, Janet S, Zheng, Zhiyuan, Jemal, Ahmedin, Ekwueme, Donatus U
Médium:	Journal Article
Jazyk:	angličtina
Vydáno:	United States 20.01.2016
Témata:	Adolescent Adult Age Factors Aged Employment - statistics & numerical data Female Health Expenditures - statistics & numerical data Humans Insurance, Health - statistics & numerical data Male Middle Aged Neoplasms - economics Neoplasms - epidemiology Poverty - statistics & numerical data Survivors - statistics & numerical data United States - epidemiology Young Adult United States
ISSN:	1527-7755
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Abstract	To estimate the prevalence of financial hardship associated with cancer in the United States and identify characteristics of cancer survivors associated with financial hardship. We identified 1,202 adult cancer survivors diagnosed or treated at ≥ 18 years of age from the 2011 Medical Expenditure Panel Survey Experiences With Cancer questionnaire. Material financial hardship was measured by ever (1) borrowing money or going into debt, (2) filing for bankruptcy, (3) being unable to cover one's share of medical care costs, or (4) making other financial sacrifices because of cancer, its treatment, and lasting effects of treatment. Psychological financial hardship was measured as ever worrying about paying large medical bills. We examined factors associated with any material or psychological financial hardship using separate multivariable logistic regression models stratified by age group (18 to 64 and ≥ 65 years). Material financial hardship was more common in cancer survivors age 18 to 64 years than in those ≥ 65 years of age (28.4% v 13.8%; P < .001), as was psychological financial hardship (31.9% v 14.7%, P < .001). In adjusted analyses, cancer survivors age 18 to 64 years who were younger, female, nonwhite, and treated more recently and who had changed employment because of cancer were significantly more likely to report any material financial hardship. Cancer survivors who were uninsured, had lower family income, and were treated more recently were more likely to report psychological financial hardship. Among cancer survivors ≥ 65 years of age, those who were younger were more likely to report any financial hardship. Cancer survivors, especially the working-age population, commonly experience material and psychological financial hardship.
AbstractList	PURPOSETo estimate the prevalence of financial hardship associated with cancer in the United States and identify characteristics of cancer survivors associated with financial hardship.METHODSWe identified 1,202 adult cancer survivors diagnosed or treated at ≥ 18 years of age from the 2011 Medical Expenditure Panel Survey Experiences With Cancer questionnaire. Material financial hardship was measured by ever (1) borrowing money or going into debt, (2) filing for bankruptcy, (3) being unable to cover one's share of medical care costs, or (4) making other financial sacrifices because of cancer, its treatment, and lasting effects of treatment. Psychological financial hardship was measured as ever worrying about paying large medical bills. We examined factors associated with any material or psychological financial hardship using separate multivariable logistic regression models stratified by age group (18 to 64 and ≥ 65 years).RESULTSMaterial financial hardship was more common in cancer survivors age 18 to 64 years than in those ≥ 65 years of age (28.4% v 13.8%; P < .001), as was psychological financial hardship (31.9% v 14.7%, P < .001). In adjusted analyses, cancer survivors age 18 to 64 years who were younger, female, nonwhite, and treated more recently and who had changed employment because of cancer were significantly more likely to report any material financial hardship. Cancer survivors who were uninsured, had lower family income, and were treated more recently were more likely to report psychological financial hardship. Among cancer survivors ≥ 65 years of age, those who were younger were more likely to report any financial hardship.CONCLUSIONCancer survivors, especially the working-age population, commonly experience material and psychological financial hardship. To estimate the prevalence of financial hardship associated with cancer in the United States and identify characteristics of cancer survivors associated with financial hardship. We identified 1,202 adult cancer survivors diagnosed or treated at ≥ 18 years of age from the 2011 Medical Expenditure Panel Survey Experiences With Cancer questionnaire. Material financial hardship was measured by ever (1) borrowing money or going into debt, (2) filing for bankruptcy, (3) being unable to cover one's share of medical care costs, or (4) making other financial sacrifices because of cancer, its treatment, and lasting effects of treatment. Psychological financial hardship was measured as ever worrying about paying large medical bills. We examined factors associated with any material or psychological financial hardship using separate multivariable logistic regression models stratified by age group (18 to 64 and ≥ 65 years). Material financial hardship was more common in cancer survivors age 18 to 64 years than in those ≥ 65 years of age (28.4% v 13.8%; P < .001), as was psychological financial hardship (31.9% v 14.7%, P < .001). In adjusted analyses, cancer survivors age 18 to 64 years who were younger, female, nonwhite, and treated more recently and who had changed employment because of cancer were significantly more likely to report any material financial hardship. Cancer survivors who were uninsured, had lower family income, and were treated more recently were more likely to report psychological financial hardship. Among cancer survivors ≥ 65 years of age, those who were younger were more likely to report any financial hardship. Cancer survivors, especially the working-age population, commonly experience material and psychological financial hardship.
Author	Jemal, Ahmedin Kent, Erin E Banegas, Matthew P Blanch-Hartigan, Danielle McNeel, Timothy S de Moor, Janet S Rodriguez, Juan L Zheng, Zhiyuan Guy, Jr, Gery P Han, Xuesong Chawla, Neetu Davidoff, Amy Li, Chunyu Virgo, Katherine S Dowling, Emily C Yabroff, K Robin Ekwueme, Donatus U
Author_xml	– sequence: 1 givenname: K Robin surname: Yabroff fullname: Yabroff, K Robin email: robin.yabroff@hhs.gov organization: K. Robin Yabroff, Matthew P. Banegas, Neetu Chawla, Danielle Blanch-Hartigan, Erin E. Kent, and Janet S. de Moor, National Cancer Institute, Bethesda; Timothy S. McNeel, Information Management Services, Calverton, MD; Emily C. Dowling, Massachusetts General Hospital, Boston; Danielle Blanch-Hartigan, Bentley University, Waltham, MA; Gery P. Guy Jr, Chunyu Li, Juan L. Rodriguez, and Donatus U. Ekwueme, Centers for Disease Control and Prevention; Xuesong Han, Zhiyuan Zheng, and Ahmedin Jemal, American Cancer Society; Katherine S. Virgo, Emory University, Atlanta, GA; Amy Davidoff, Yale School of Public Health, New Haven, CT; and Neetu Chawla, Kaiser Permanente Northern California, Oakland, CA. robin.yabroff@hhs.gov – sequence: 2 givenname: Emily C surname: Dowling fullname: Dowling, Emily C organization: K. Robin Yabroff, Matthew P. Banegas, Neetu Chawla, Danielle Blanch-Hartigan, Erin E. Kent, and Janet S. de Moor, National Cancer Institute, Bethesda; Timothy S. McNeel, Information Management Services, Calverton, MD; Emily C. Dowling, Massachusetts General Hospital, Boston; Danielle Blanch-Hartigan, Bentley University, Waltham, MA; Gery P. Guy Jr, Chunyu Li, Juan L. Rodriguez, and Donatus U. Ekwueme, Centers for Disease Control and Prevention; Xuesong Han, Zhiyuan Zheng, and Ahmedin Jemal, American Cancer Society; Katherine S. Virgo, Emory University, Atlanta, GA; Amy Davidoff, Yale School of Public Health, New Haven, CT; and Neetu Chawla, Kaiser Permanente Northern California, Oakland, CA – sequence: 3 givenname: Gery P surname: Guy, Jr fullname: Guy, Jr, Gery P organization: K. Robin Yabroff, Matthew P. Banegas, Neetu Chawla, Danielle Blanch-Hartigan, Erin E. Kent, and Janet S. de Moor, National Cancer Institute, Bethesda; Timothy S. McNeel, Information Management Services, Calverton, MD; Emily C. Dowling, Massachusetts General Hospital, Boston; Danielle Blanch-Hartigan, Bentley University, Waltham, MA; Gery P. Guy Jr, Chunyu Li, Juan L. Rodriguez, and Donatus U. Ekwueme, Centers for Disease Control and Prevention; Xuesong Han, Zhiyuan Zheng, and Ahmedin Jemal, American Cancer Society; Katherine S. Virgo, Emory University, Atlanta, GA; Amy Davidoff, Yale School of Public Health, New Haven, CT; and Neetu Chawla, Kaiser Permanente Northern California, Oakland, CA – sequence: 4 givenname: Matthew P surname: Banegas fullname: Banegas, Matthew P organization: K. Robin Yabroff, Matthew P. Banegas, Neetu Chawla, Danielle Blanch-Hartigan, Erin E. Kent, and Janet S. de Moor, National Cancer Institute, Bethesda; Timothy S. McNeel, Information Management Services, Calverton, MD; Emily C. Dowling, Massachusetts General Hospital, Boston; Danielle Blanch-Hartigan, Bentley University, Waltham, MA; Gery P. Guy Jr, Chunyu Li, Juan L. Rodriguez, and Donatus U. Ekwueme, Centers for Disease Control and Prevention; Xuesong Han, Zhiyuan Zheng, and Ahmedin Jemal, American Cancer Society; Katherine S. Virgo, Emory University, Atlanta, GA; Amy Davidoff, Yale School of Public Health, New Haven, CT; and Neetu Chawla, Kaiser Permanente Northern California, Oakland, CA – sequence: 5 givenname: Amy surname: Davidoff fullname: Davidoff, Amy organization: K. Robin Yabroff, Matthew P. Banegas, Neetu Chawla, Danielle Blanch-Hartigan, Erin E. Kent, and Janet S. de Moor, National Cancer Institute, Bethesda; Timothy S. McNeel, Information Management Services, Calverton, MD; Emily C. Dowling, Massachusetts General Hospital, Boston; Danielle Blanch-Hartigan, Bentley University, Waltham, MA; Gery P. Guy Jr, Chunyu Li, Juan L. Rodriguez, and Donatus U. Ekwueme, Centers for Disease Control and Prevention; Xuesong Han, Zhiyuan Zheng, and Ahmedin Jemal, American Cancer Society; Katherine S. Virgo, Emory University, Atlanta, GA; Amy Davidoff, Yale School of Public Health, New Haven, CT; and Neetu Chawla, Kaiser Permanente Northern California, Oakland, CA – sequence: 6 givenname: Xuesong surname: Han fullname: Han, Xuesong organization: K. Robin Yabroff, Matthew P. Banegas, Neetu Chawla, Danielle Blanch-Hartigan, Erin E. Kent, and Janet S. de Moor, National Cancer Institute, Bethesda; Timothy S. McNeel, Information Management Services, Calverton, MD; Emily C. Dowling, Massachusetts General Hospital, Boston; Danielle Blanch-Hartigan, Bentley University, Waltham, MA; Gery P. Guy Jr, Chunyu Li, Juan L. Rodriguez, and Donatus U. Ekwueme, Centers for Disease Control and Prevention; Xuesong Han, Zhiyuan Zheng, and Ahmedin Jemal, American Cancer Society; Katherine S. Virgo, Emory University, Atlanta, GA; Amy Davidoff, Yale School of Public Health, New Haven, CT; and Neetu Chawla, Kaiser Permanente Northern California, Oakland, CA – sequence: 7 givenname: Katherine S surname: Virgo fullname: Virgo, Katherine S organization: K. Robin Yabroff, Matthew P. Banegas, Neetu Chawla, Danielle Blanch-Hartigan, Erin E. Kent, and Janet S. de Moor, National Cancer Institute, Bethesda; Timothy S. McNeel, Information Management Services, Calverton, MD; Emily C. Dowling, Massachusetts General Hospital, Boston; Danielle Blanch-Hartigan, Bentley University, Waltham, MA; Gery P. Guy Jr, Chunyu Li, Juan L. Rodriguez, and Donatus U. Ekwueme, Centers for Disease Control and Prevention; Xuesong Han, Zhiyuan Zheng, and Ahmedin Jemal, American Cancer Society; Katherine S. Virgo, Emory University, Atlanta, GA; Amy Davidoff, Yale School of Public Health, New Haven, CT; and Neetu Chawla, Kaiser Permanente Northern California, Oakland, CA – sequence: 8 givenname: Timothy S surname: McNeel fullname: McNeel, Timothy S organization: K. Robin Yabroff, Matthew P. Banegas, Neetu Chawla, Danielle Blanch-Hartigan, Erin E. Kent, and Janet S. de Moor, National Cancer Institute, Bethesda; Timothy S. McNeel, Information Management Services, Calverton, MD; Emily C. Dowling, Massachusetts General Hospital, Boston; Danielle Blanch-Hartigan, Bentley University, Waltham, MA; Gery P. Guy Jr, Chunyu Li, Juan L. Rodriguez, and Donatus U. Ekwueme, Centers for Disease Control and Prevention; Xuesong Han, Zhiyuan Zheng, and Ahmedin Jemal, American Cancer Society; Katherine S. Virgo, Emory University, Atlanta, GA; Amy Davidoff, Yale School of Public Health, New Haven, CT; and Neetu Chawla, Kaiser Permanente Northern California, Oakland, CA – sequence: 9 givenname: Neetu surname: Chawla fullname: Chawla, Neetu organization: K. Robin Yabroff, Matthew P. Banegas, Neetu Chawla, Danielle Blanch-Hartigan, Erin E. Kent, and Janet S. de Moor, National Cancer Institute, Bethesda; Timothy S. McNeel, Information Management Services, Calverton, MD; Emily C. Dowling, Massachusetts General Hospital, Boston; Danielle Blanch-Hartigan, Bentley University, Waltham, MA; Gery P. Guy Jr, Chunyu Li, Juan L. Rodriguez, and Donatus U. Ekwueme, Centers for Disease Control and Prevention; Xuesong Han, Zhiyuan Zheng, and Ahmedin Jemal, American Cancer Society; Katherine S. Virgo, Emory University, Atlanta, GA; Amy Davidoff, Yale School of Public Health, New Haven, CT; and Neetu Chawla, Kaiser Permanente Northern California, Oakland, CA – sequence: 10 givenname: Danielle surname: Blanch-Hartigan fullname: Blanch-Hartigan, Danielle organization: K. Robin Yabroff, Matthew P. Banegas, Neetu Chawla, Danielle Blanch-Hartigan, Erin E. Kent, and Janet S. de Moor, National Cancer Institute, Bethesda; Timothy S. McNeel, Information Management Services, Calverton, MD; Emily C. Dowling, Massachusetts General Hospital, Boston; Danielle Blanch-Hartigan, Bentley University, Waltham, MA; Gery P. Guy Jr, Chunyu Li, Juan L. Rodriguez, and Donatus U. Ekwueme, Centers for Disease Control and Prevention; Xuesong Han, Zhiyuan Zheng, and Ahmedin Jemal, American Cancer Society; Katherine S. Virgo, Emory University, Atlanta, GA; Amy Davidoff, Yale School of Public Health, New Haven, CT; and Neetu Chawla, Kaiser Permanente Northern California, Oakland, CA – sequence: 11 givenname: Erin E surname: Kent fullname: Kent, Erin E organization: K. Robin Yabroff, Matthew P. Banegas, Neetu Chawla, Danielle Blanch-Hartigan, Erin E. Kent, and Janet S. de Moor, National Cancer Institute, Bethesda; Timothy S. McNeel, Information Management Services, Calverton, MD; Emily C. Dowling, Massachusetts General Hospital, Boston; Danielle Blanch-Hartigan, Bentley University, Waltham, MA; Gery P. Guy Jr, Chunyu Li, Juan L. Rodriguez, and Donatus U. Ekwueme, Centers for Disease Control and Prevention; Xuesong Han, Zhiyuan Zheng, and Ahmedin Jemal, American Cancer Society; Katherine S. Virgo, Emory University, Atlanta, GA; Amy Davidoff, Yale School of Public Health, New Haven, CT; and Neetu Chawla, Kaiser Permanente Northern California, Oakland, CA – sequence: 12 givenname: Chunyu surname: Li fullname: Li, Chunyu organization: K. Robin Yabroff, Matthew P. Banegas, Neetu Chawla, Danielle Blanch-Hartigan, Erin E. Kent, and Janet S. de Moor, National Cancer Institute, Bethesda; Timothy S. McNeel, Information Management Services, Calverton, MD; Emily C. Dowling, Massachusetts General Hospital, Boston; Danielle Blanch-Hartigan, Bentley University, Waltham, MA; Gery P. Guy Jr, Chunyu Li, Juan L. Rodriguez, and Donatus U. Ekwueme, Centers for Disease Control and Prevention; Xuesong Han, Zhiyuan Zheng, and Ahmedin Jemal, American Cancer Society; Katherine S. Virgo, Emory University, Atlanta, GA; Amy Davidoff, Yale School of Public Health, New Haven, CT; and Neetu Chawla, Kaiser Permanente Northern California, Oakland, CA – sequence: 13 givenname: Juan L surname: Rodriguez fullname: Rodriguez, Juan L organization: K. Robin Yabroff, Matthew P. Banegas, Neetu Chawla, Danielle Blanch-Hartigan, Erin E. Kent, and Janet S. de Moor, National Cancer Institute, Bethesda; Timothy S. McNeel, Information Management Services, Calverton, MD; Emily C. Dowling, Massachusetts General Hospital, Boston; Danielle Blanch-Hartigan, Bentley University, Waltham, MA; Gery P. Guy Jr, Chunyu Li, Juan L. Rodriguez, and Donatus U. Ekwueme, Centers for Disease Control and Prevention; Xuesong Han, Zhiyuan Zheng, and Ahmedin Jemal, American Cancer Society; Katherine S. Virgo, Emory University, Atlanta, GA; Amy Davidoff, Yale School of Public Health, New Haven, CT; and Neetu Chawla, Kaiser Permanente Northern California, Oakland, CA – sequence: 14 givenname: Janet S surname: de Moor fullname: de Moor, Janet S organization: K. Robin Yabroff, Matthew P. Banegas, Neetu Chawla, Danielle Blanch-Hartigan, Erin E. Kent, and Janet S. de Moor, National Cancer Institute, Bethesda; Timothy S. McNeel, Information Management Services, Calverton, MD; Emily C. Dowling, Massachusetts General Hospital, Boston; Danielle Blanch-Hartigan, Bentley University, Waltham, MA; Gery P. Guy Jr, Chunyu Li, Juan L. Rodriguez, and Donatus U. Ekwueme, Centers for Disease Control and Prevention; Xuesong Han, Zhiyuan Zheng, and Ahmedin Jemal, American Cancer Society; Katherine S. Virgo, Emory University, Atlanta, GA; Amy Davidoff, Yale School of Public Health, New Haven, CT; and Neetu Chawla, Kaiser Permanente Northern California, Oakland, CA – sequence: 15 givenname: Zhiyuan surname: Zheng fullname: Zheng, Zhiyuan organization: K. Robin Yabroff, Matthew P. Banegas, Neetu Chawla, Danielle Blanch-Hartigan, Erin E. Kent, and Janet S. de Moor, National Cancer Institute, Bethesda; Timothy S. McNeel, Information Management Services, Calverton, MD; Emily C. Dowling, Massachusetts General Hospital, Boston; Danielle Blanch-Hartigan, Bentley University, Waltham, MA; Gery P. Guy Jr, Chunyu Li, Juan L. Rodriguez, and Donatus U. Ekwueme, Centers for Disease Control and Prevention; Xuesong Han, Zhiyuan Zheng, and Ahmedin Jemal, American Cancer Society; Katherine S. Virgo, Emory University, Atlanta, GA; Amy Davidoff, Yale School of Public Health, New Haven, CT; and Neetu Chawla, Kaiser Permanente Northern California, Oakland, CA – sequence: 16 givenname: Ahmedin surname: Jemal fullname: Jemal, Ahmedin organization: K. Robin Yabroff, Matthew P. Banegas, Neetu Chawla, Danielle Blanch-Hartigan, Erin E. Kent, and Janet S. de Moor, National Cancer Institute, Bethesda; Timothy S. McNeel, Information Management Services, Calverton, MD; Emily C. Dowling, Massachusetts General Hospital, Boston; Danielle Blanch-Hartigan, Bentley University, Waltham, MA; Gery P. Guy Jr, Chunyu Li, Juan L. Rodriguez, and Donatus U. Ekwueme, Centers for Disease Control and Prevention; Xuesong Han, Zhiyuan Zheng, and Ahmedin Jemal, American Cancer Society; Katherine S. Virgo, Emory University, Atlanta, GA; Amy Davidoff, Yale School of Public Health, New Haven, CT; and Neetu Chawla, Kaiser Permanente Northern California, Oakland, CA – sequence: 17 givenname: Donatus U surname: Ekwueme fullname: Ekwueme, Donatus U organization: K. Robin Yabroff, Matthew P. Banegas, Neetu Chawla, Danielle Blanch-Hartigan, Erin E. Kent, and Janet S. de Moor, National Cancer Institute, Bethesda; Timothy S. McNeel, Information Management Services, Calverton, MD; Emily C. Dowling, Massachusetts General Hospital, Boston; Danielle Blanch-Hartigan, Bentley University, Waltham, MA; Gery P. Guy Jr, Chunyu Li, Juan L. Rodriguez, and Donatus U. Ekwueme, Centers for Disease Control and Prevention; Xuesong Han, Zhiyuan Zheng, and Ahmedin Jemal, American Cancer Society; Katherine S. Virgo, Emory University, Atlanta, GA; Amy Davidoff, Yale School of Public Health, New Haven, CT; and Neetu Chawla, Kaiser Permanente Northern California, Oakland, CA
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Snippet	To estimate the prevalence of financial hardship associated with cancer in the United States and identify characteristics of cancer survivors associated with... PURPOSETo estimate the prevalence of financial hardship associated with cancer in the United States and identify characteristics of cancer survivors associated...
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SubjectTerms	Adolescent Adult Age Factors Aged Employment - statistics & numerical data Female Health Expenditures - statistics & numerical data Humans Insurance, Health - statistics & numerical data Male Middle Aged Neoplasms - economics Neoplasms - epidemiology Poverty - statistics & numerical data Survivors - statistics & numerical data United States - epidemiology Young Adult
Title	Financial Hardship Associated With Cancer in the United States: Findings From a Population-Based Sample of Adult Cancer Survivors
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