The Financial Stress of Cancer

High deductibles, copays, the costs for treatments and doctors’ visits can add up for patients who have a cancer diagnosis. Two new studies take a look at the financial hardships faced by patients with cancer.

Both studies suggest there is a need for interventions that focus on improving health insurance coverage for those with cancer.

The first, a new paper published in CA: A Cancer Journal for Clinicians, the flagship journal of the American Cancer Society, talks about how a cancer diagnosis can lead to employment disruptions, loss of income, and potential loss of health insurance coverage.

K. Robin Yabroff, Ph.D.

Researchers — led by K. Robin Yabroff, Ph.D., scientific vice president, Health Services Research at American Cancer Society — summarized existing research and provided estimates from the most recently available years of the National Health Interview Survey, 2019–2021. The NHIS is a large annual household survey that collects information from almost 90,000 people in the United States. This survey asks about health conditions, including cancer diagnoses, health status, employment, health insurance coverage, socioeconomic status, and experiences with healthcare.

They found that among adults aged 18 to 64 years of age with a cancer diagnosis, more than half experienced financial hardships. Of these, 21% had trouble paying medical bills and 12% delayed care. This most common among those who are less than 200% of the federal poverty level but also impacts those with higher household incomes.

For people with cancer who have private insurance, monthly premiums, deductibles and cost-sharing impacts their financial status. The authors state high deductible plans have grown, from 14% of employer sponsored plans in 2007 to 43.4% in 2017. The average deductible in 2022 was $3,811 for a family and $1,992 for an individual.

Working-age adults with a cancer history are more likely than those without a cancer history to report being unable to work because of health problems. They also missed days from work than those without cancer. The authors noted that previous research estimated that the per capita annual productivity losses were $4,694 during the first year after the cancer diagnosis and $3,593 after the first year. Numbers are in 2010 U.S. dollars.

A second paper, published in the April 2024 issue of JNCI Cancer Spectrum, looks at expenses and nonemployment in younger cancer patients, those 18 to 39 years of age,

In this study, researchers — led by Lihua Li, Ph.D., Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai — matched 962 cancer survivors from the Medical Expenditure Panel Survey to 2,733 controls.

Grace L. Smith, M.D., Ph.D., MPH

They found that young adult cancer survivors were more likely to report material financial hardship compared with those without cancer (22.8% vs 15.2%). They also found that cancer survivors with no insurance coverage or who have multiple chronic diseases were more than likely to experience financial hardship. Hispanic and other racial and ethnic young adult cancer survivors were more likely to report financial worry.

“Findings from this study provide novel insights that highlight multilevel, dynamic aspects of financial toxicity that impact individuals with a cancer diagnosis more frequently than individuals without a history of cancer,” Grace L. Smith, M.D., Ph.D., MPH, wrote in an accompanying editorial. “Whether policy shifts may also be able to render a favorable impact on the overall proportion and severity of younger populations experiencing cancer-related financial toxicity will need ongoing examination.”

Smith is in the Department of GI Radiation Oncology, Division of Radiation Oncology at MD Anderson Cancer Center.