Cost concerns prevent many cancer survivors from getting medical care

Published early online in Cancer, a peer-reviewed journal of the American Cancer Society, the study raises the concern that the long-term health and well-being of cancer survivors could suffer because patients have financial worries about their care.

A team led by Kathryn E. Weaver, Ph.D., M.P.H., an assistant professor in the Division of Public Health Sciences and lead author on the study, examined the prevalence of forgoing different types of health care due to financial concerns. Researchers sought to determine whether cancer history and race or ethnicity were associated with individuals' likelihood to go without care.

The investigators analyzed information from the annual U.S. National Health Interview Survey (NHIS), an in-person, nationwide survey of 30,000 to 40,000 households in the civilian, non-institutionalized population that is used to track trends in illness and disability in the United States. Data from 6,602 adult cancer survivors and 104,364 individuals with no history of cancer, who were surveyed in the 2003 to 2006 NHIS, were included in the study.

The analysis showed that among cancer survivors, the prevalence of forgoing care in the past year due to concerns about cost was 7.8 percent for medical care, 9.9 percent for prescription medications, 11.3 percent for dental care, and 2.7 percent for mental health care. Cancer survivors under the age of 65 years were one and a half to two times more likely to delay or forgo all types of medical care than their same-age peers without a history of cancer. Hispanic and black cancer survivors were more likely to go without prescription medications and dental care than white survivors.

"Although the large number of survivors going without care was somewhat surprising, it has long been recognized that cancer can have a negative impact on the financial health of survivors," Weaver said. "This is important because cancer survivors have many medical needs that persist for years after their diagnosis and treatment. The implications of this financial stress for their ongoing medical care are just beginning to be recognized."

The analysis revealed that 18 percent of U.S. cancer survivors, which represents more than two million individuals, did not get one or more needed medical services because of financial concerns.

"Future research needs to examine the impact of forgoing care on survivors' quality of life and survival," the authors wrote. Weaver added that it was not clear from this study what specific types of medical care were not being received and whether the services were cancer-related. She also noted that it will be interesting to observe how recent health care reform efforts might impact access to care for cancer survivors in the coming years.

Co-authors on the study, funded by the National Cancer Institute's Cancer Prevention Fellowship Program, included Julia H. Rowland, Ph.D., and Noreen M. Aziz, M.D., Ph.D., of the National Cancer Institute, and Keith M. Bellizzi, Ph.D., M.P.H., of the University of Connecticut.