Cost-Conscious Cancer Survivors Skip Care

Research suggests millions are going without needed medical services

Millions of Americans with a history of cancer, particularly people under age 65, are delaying or skimping on medical care because of worries about the cost of treatment, a new study suggests.

The finding raises troubling questions about the long-term survival and quality of life of the 12 million adults in the United States whose lives have been forever changed by a diagnosis of cancer.

"I think it's concerning because we recognize that cancer survivors have many medical needs that persist for years after their diagnosis and treatment," said study lead author Kathryn E. Weaver, an assistant professor in the Department of Social Sciences & Health Policy at Wake Forest University Baptist Medical Center in Winston-Salem, N.C.

The report was published online June 14 in Cancer, a journal of the American Cancer Society.

Cost concerns have posed a threat to cancer survivorship for some time, particularly with the advent of new, life-prolonging treatments.

Dr. Patricia Ganz, a professor in the Department of Health Services at the University of California, Los Angeles School of Public Health, served on the Institute of Medicine committee that wrote the 2005 report, From Cancer Patient to Cancer Survivor: Lost in Transition.

"One of the things that we really emphasized was lack of insurance, particularly for follow-up care," she said.

CancerCare, a New York City-based nonprofit support group for cancer patients, provides co-payment assistance for certain cancer medications.

"Cancer is a vey expensive disease and it's becoming more and more expensive," said Jeanie M. Barnett, CancerCare's director of communications. "The costs of the drugs are going up. So, too, is the proportion that the patient pays out of pocket," she said.

A March 17 commentary in the Journal of the American Medical Association, titled "Cancer's Next Frontier -- Addressing High and Increasing Costs," reported that the direct costs of cancer had swelled from $27 billion in 1990 to more than $90 billion in 2008.

The new study attempts to tease out the prevalence of forgoing medical care due to financial concerns.

"We've known for a long time that cancer can have a negative impact on the financial health of survivors," Weaver explained, "but we didn't know what implications this financial stress might have for their ongoing medical care, even long after their diagnosis."

To explore that issue, the researchers used data from the U.S. National Health Interview Survey from 2003 to 2006. The findings are based on a sample of 6,602 adult cancer survivors and 104,364 people without a cancer diagnosis.

Among cancer survivors, the prevalence of forgoing care in the past year due to cost concerns 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.

Nearly 18 percent of cancer survivors -- an estimated 2 million Americans -- went without one or more medical services because of financial concerns. Younger survivors, under age 65, were one-and-a-half to two times more likely to forgo or delay medical services, the study revealed.

And black and Hispanic cancer survivors were more likely to forgo prescription drugs and dental care than white survivors, the study found.

What procedures or treatments are cancer survivors skipping? The data wasn't that specific, Ganz explained, "so it's hard to judge: Was it a routine test? Was it for cardiovascular problems? Or was it a test that might pick up a cancer recurrence?"

Nevertheless, the study does raise questions about the health of cancer survivors. "Certainly that's going to impact your quality of life regardless of whether it's cancer-specific or not," Weaver said.

What's needed is better guidance on follow-up care so that cancer survivors get essential services and avoid unnecessary tests and procedures, Ganz said.

And, added Weaver, the medical system needs to do a better job of counseling patients about financial barriers to care. "Instead of [patients] saying, 'Well, you know, I can't afford this medication,' they just may not fill it. So I think it needs to become part of the conversation."

The new federal health reform legislation may help address the gap in follow-up care by making insurance coverage more available and affordable, Ganz said.

More information

The American Society of Clinical Oncology has more on managing the cost of cancer care.