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J Clin Oncol. 2017 Oct 20;35(30):3474-3481. doi: 10.1200/JCO.2016.71.7066. Epub 2017 Aug 17.

Financial Burden in Survivors of Childhood Cancer: A Report From the Childhood Cancer Survivor Study.

Author information

1
Ryan D. Nipp, Julia Rabin, Kelly A. Hyland, Karen Kuhlthau, Giselle K. Perez, and Elyse R. Park, Massachusetts General Hospital; Ryan D. Nipp, Karen Kuhlthau, Giselle K. Perez, and Elyse R. Park, Harvard Medical School, Boston, MA; Anne C. Kirchhoff, Douglas Fair, Huntsman Cancer Institute, Salt Lake City, UT; Leslie L. Robison and Gregory T. Armstrong, St Jude Children's Research Hospital, Memphis, TN; Paul C. Nathan, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Kevin C. Oeffinger, Memorial Sloan Kettering Cancer Center, New York, NY; and Wendy M. Leisenring, Fred Hutchinson Cancer Research Center, Seattle, WA.

Abstract

Purpose Survivors of childhood cancer may experience financial burden as a result of health care costs, particularly because these patients often require long-term medical care. We sought to evaluate the prevalence of financial burden and identify associations between a higher percentage of income spent on out-of-pocket medical costs (≥ 10% of annual income) and issues related to financial burden (jeopardizing care or changing lifestyle) among survivors of childhood cancer and a sibling comparison group. Methods Between May 2011 and April 2012, we surveyed an age-stratified, random sample of survivors of childhood cancer and a sibling comparison group who were enrolled in the Childhood Cancer Survivor Study. Participants reported their household income, out-of-pocket medical costs, and issues related to financial burden (questions were adapted from national surveys on financial burden). Logistic regression identified associations between participant characteristics, a higher percentage of income spent on out-of-pocket medical costs, and financial burden, adjusting for potential confounders. Results Among 580 survivors of childhood cancer and 173 siblings, survivors of childhood cancer were more likely to have out-of-pocket medical costs ≥ 10% of annual income (10.0% v 2.9%; P < .001). Characteristics of the survivors of childhood cancer that were associated with a higher percentage of income spent on out-of-pocket costs included hospitalization in the past year (odds ratio [OR], 2.3; 95% CI, 1.1 to 4.9) and household income < $50,000 (OR, 5.5; 95% CI, 2.4 to 12.8). Among survivors of childhood cancer, a higher percentage of income spent on out-of-pocket medical costs was significantly associated with problems paying medical bills (OR, 8.9; 95% CI, 4.4 to 18.0); deferring care for a medical problem (OR, 3.0; 95% CI, 1.6 to 5.9); skipping a test, treatment, or follow-up (OR, 2.1; 95% CI, 1.1 to 4.0); and thoughts of filing for bankruptcy (OR, 6.6; 95% CI, 3.0 to 14.3). Conclusion Survivors of childhood cancer are more likely to report spending a higher percentage of their income on out-of-pocket medical costs, which may influence their health-seeking behavior and potentially affect health outcomes. Our findings highlight the need to address financial burden in this population with long-term health care needs.

PMID:
28817372
PMCID:
PMC5648170
DOI:
10.1200/JCO.2016.71.7066
[Indexed for MEDLINE]
Free PMC Article

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