Financial Burden Among Survivors of Childhood Cancer

Key Points

  • Childhood cancer survivors were more likely to spend a higher percentage of income on out-of-pocket costs than siblings.
  • A higher percentage of income spent on such costs was associated with deferring care and missing tests, treatments, or follow-ups.

Findings from the Childhood Cancer Survivor Study, reported in the Journal of Clinical Oncology by Nipp et al, indicate that childhood cancer survivors are more likely than unaffected siblings to spend a higher percentage of income on out-of-pocket medical costs, potentially leading to reduced use of health care.

Study Details

The study involved an age-stratified random sample of 580 survivors of childhood cancer and a sibling comparison group (n = 173) enrolled in the Childhood Cancer Survivor Study. Participants reported household income, out-of-pocket medical costs, and issues related to financial burden.

Financial Burden and Consequences

Survivors of childhood cancer were more likely than siblings to have out-of-pocket medical costs ≥ 10% of annual income (10.0% vs 2.9%, P < .001). Survivor characteristics associated with a higher percentage of income spent on out-of-pocket medical costs included hospitalization in the past year (odds ratio [OR] = 2.3, 95% confidence interval [CI] = 1.1–4.9) and household income < $50,000 (OR = 5.5, 95% CI = 2.4–12.8). Higher percentage of income spent on out-of-pocket medical costs among survivors was associated with problems paying medical bills (OR = 8.9, 95% CI = 4.4–18.0); deferring care for medical problems (OR = 3.0, 95% CI = 1.6–5.9); skipping a medical test, treatment, or follow-up (OR = 2.1, 95% CI = 1.1–4.0); and thoughts of filing for bankruptcy (OR = 6.6, 95% CI = 3.0–14.3).

The investigators concluded: “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.”

The study was supported by the Livestrong Foundation ad grants from the National Cancer Institute.

Ryan D. Nipp, MD, of Massachusetts General Hospital Cancer Center, Harvard Medical School, is the corresponding author of the Journal of Clinical Oncology article. 

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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