BACKGROUND: Financial hardship is common among cancer survivors and is associated with both limiting care due to cost and with poor health-related quality of life (HRQOL). This study estimates the association between limiting care due to cost and HRQOL in a diverse population of cancer survivors and tests whether limiting care mediates the association between financial hardship and HRQOL. METHODS: We used data from
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High-Deductible Health Plans and Cancer Survivorship: What Is the Association With Access to Care and Hospital Emergency Department Use?
PURPOSE: To examine the associations among high-deductible health plan (HDHP) enrollment, cancer survivorship, and access to care and utilization. MATERIALS AND METHODS: The 2010 to 2017 National Health Interview Survey was used to identify privately insured adults ages 18 to 64 years (cancer survivors, n = 4,321; individuals without a cancer history, n = 95,316). We used multivariable logistic regressions to evaluate the
The impact of cancer diagnosis and treatment on employment, income, treatment decisions and financial assistance and their relationship to socioeconomic and disease factors
PURPOSE: The financial impact of cancer diagnosis and treatment can be considerable to individuals and their households, leading to changes in treatment decision making. This study aimed to quantify effects on income and employment; describe how cost-related factors influence treatment decision making and need for financial assistance; and to identify patient sociodemographic factors associated with treatment decision
Forgoing medical care because of cost: assessing disparities in healthcare access among cancer survivors living in the United States
BACKGROUND: Many US cancer survivors live years after diagnosis, which emphasizes the importance of healthcare access for survivors. It is not known whether having cancer has an impact on disparities in healthcare access that are present in the general population. The objective of this study was to examine the prevalence of forgoing care because of financial concerns in a representative sample of US adults to
Financial hardship and the intensity of medical care received near death
BACKGROUND: Although end-of-life (EOL) care can present a substantial financial burden for the household, the influence of this burden on the intensity of care received at the EOL remains unknown. The goal of this study was to determine the association between financial hardship and intensive care in the last week of life. METHODS: The Coping with Cancer (CwC) Study is a longitudinal, multisite cohort study of terminally ill
Treatment cost and access to care: experiences of young women diagnosed with breast cancer
PURPOSE: Breast cancer is the leading cause of cancer-related deaths in women younger than 40 years. We aim to evaluate cost as a barrier to care among female breast cancer patients diagnosed between 18 to 39 years. METHODS: In early 2017, we distributed a survey to women diagnosed with breast cancer between the ages of 18 and 39 years, as identified by the central cancer registries of California, Georgia, North
Impact of rural residence on forgoing healthcare after cancer because of cost
BACKGROUND: Routine follow-up care is recommended to promote the well-being of cancer survivors, but financial difficulties may interfere. Rural-urban disparities in forgoing healthcare due to cost have been observed in the general population; however, it is unknown whether this disparity persists among survivors. The purpose of this study was to examine rural-urban disparities in forgoing healthcare after cancer due to
Factors Associated With Use of High-Cost Agents for the Treatment of Metastatic Non-Small Cell Lung Cancer
BACKGROUND: Antineoplastic agents approved in recent decades are a marked advancement in cancer treatment, but they come at considerable cost. These drugs may widen survival disparities between patients who receive these agents and those who do not. We examine factors associated with the use of high-cost antineoplastic agents for the treatment of metastatic non-small cell lung cancer. METHODS: We conducted a
Annual Spending per Patient and Quality in Hospital-Owned Versus Physician-Owned Organizations: an Observational Study
BACKGROUND: Recent studies that compared patient spending in hospital-owned physician practices versus physician-owned groups did not compare quality of care. Past studies had incomplete measures of physician-hospital integration, or lacked patient-level data. OBJECTIVE: To measure the association between physician-hospital integration and both spending and quality using patient-level data and explicit physician-hospital
Financial burden of cancer care under the Affordable Care Act: Analysis of MEPS-Experiences with Cancer Survivorship 2011 and 2016
PURPOSE: To examine whether the implementation of Affordable Care Act (ACA) reduced the financial burden associated with cancer care among non-elderly cancer survivors. METHODS: Using data from the MEPS-Experiences with Cancer Survivorship Survey, we examined whether there was a difference in financial burden associated with cancer care between 2011 (pre-ACA) and 2016 (post-ACA). Two aspects of financial burden
Cancer History, Health Insurance Coverage, and Cost-Related Medication Nonadherence and Medication Cost-Coping Strategies in the United States
OBJECTIVES: To evaluate the relationship between cancer history and cost-related medication nonadherence (CRN) as well as cost-coping strategies, by health insurance coverage. METHODS: We used the 2013 to 2016 National Health Interview Survey to identify adults aged 18 to 64 years with (n = 3599) and without (n = 56 909) a cancer history. Cost-related changes in medication use included (1) CRN, measured as skipping, taking
Insurance and inpatient care: differences in length of stay and costs between surgically treated cancer patients
BACKGROUND: Early research demonstrated that patients’ length-of-stay and inpatient costs varied according to their health insurance status. The authors of the current report studied a population-based sample of privately insured, Medicaid-insured, and uninsured inpatients ages 21 to 64 years who underwent surgical resection for either nonsmall cell lung cancer (NSCLC) (n = 781) or colorectal cancer (CRC) (n = 8190)
You Have to Keep a Roof Over Your Head: A Qualitative Study of Housing Needs Among Patients With Cancer in New York City
PURPOSE: Housing status can become compromised in the wake of financial hardship for some patients with cancer and become a source of disparity. This qualitative study describes the types of housing issues experienced by patients with cancer and survivors of cancer in New York City. METHODS: Semistructured interviews were conducted with a volunteer sample of 21 patients with cancer or survivors of cancer treated in
Women With Breast Cancer Who Work For Accommodating Employers More Likely To Retain Jobs After Treatment
Breast cancer affects one in eight women across the United States, and low-income minority survivors of breast cancer are at increased risk of job loss, compared to higher-income white survivors. Employer accommodations, such as schedule flexibility, have been associated with job retention in higher-income whites, but the role of such accommodations in job retention among low-income minorities is not well
Long-Term Economic and Employment Outcomes Among Partners of Women With Early-Stage Breast Cancer
PURPOSE: Work loss is one of many personal costs for patients with cancer and their families. Many women with breast cancer face long-term job loss that stems from their diagnoses. However, little is known about the economic and employment outcomes of partners of women with breast cancer. METHODS: Women with nonmetastatic breast cancer identified by the Detroit and Los Angeles SEER registries between June 2005 and
Co-payment policies and breast and cervical cancer screening in Medicaid
OBJECTIVES: This study investigated the relationship between state Medicaid co-payment policies and cancer screening for Medicaid-enrolled women. STUDY DESIGN: Cross-sectional analysis of administrative claims and enrollment data. METHODS: Our data included Medicaid Analytic eXtract (MAX) outpatient claims files across 43 states in 2003, 2008, and 2010, the years for which both MAX data and state cost-sharing data
Colorectal cancer survivors’ challenges to returning to work: A qualitative study
OBJECTIVE: To assess the challenges and needs of colorectal cancer (CRC) survivors in maintaining employment and returning to work (RTW) from the perspectives of both CRC survivors and employers in the United States. METHODS: Semi-structured interviews with CRC survivors (n = 10) and employers (n = 4) were transcribed, coded and thematically analysed using NVivo 12 software. RESULTS: Workplace challenges for
Recommendations for Research and Practice to Improve Work Outcomes Among Cancer Survivors
Major knowledge gaps limit the development and implementation of interventions to improve employment outcomes among people with cancer. To identify research priorities to improve employment outcomes after cancer, the National Cancer Institute sponsored the meeting “Evidence-Based Approaches for Optimizing Employment Outcomes among Cancer Survivors.”
Absenteeism from work: the experience of employed breast and prostate cancer patients in the months following diagnosis
A better understanding of how cancer treatments affect patient’s employment may help patients and physicians make more informed choices between treatment alternatives. This study examined the number of days employed patients undergoing treatment for either breast or prostate cancer were absent from their jobs.
Employment and cancer: findings from a longitudinal study of breast and prostate cancer survivors
We discuss how cancer affected the employment of almost 800 employed patients who participated in a longitudinal study. The greatest reduction in patients’ labor supply (defined as employment and weekly hours worked) was observed 6 months following diagnosis.
Employment outcomes of men treated for prostate cancer
Some organizations recommend prostate cancer screening for men younger than age 65 years, many of whom will be employed when they are diagnosed and treated for prostate cancer. Yet little is known about how prostate cancer and its treatment affect men’s employment status. Consequently, we explored employment outcomes 6 and 12 months after the diagnosis of prostate cancer.
Acute myeloid leukemia: how the uninsured fare
Bradley, C. J., Dahman, B., Jin, Y., Shickle, L. M., Ginder, G. D. African American race and uninsurance are associated with undertreatment and poor survival in solid tumor cancers. This relationship has not been examined in acute myeloid leukemia (AML) where absence...
Supportive health education reduces health care utilization and costs in Latinas with breast cancer and their caregivers
To compare costs and relative cost savings from reductions in unscheduled health services use for two 8-week psychosocial interventions (telephone interpersonal counseling [TIPC], supportive health education [SHE]) delivered by telephone to Latinas with breast cancer and their informal caregivers. Cost information is required before adopting supportive care interventions as part of routine care.