Cost Burden Diminishes Care Quality in Minority Cancer Patients

By John Henry Dreyfuss, MDalert.com staff.

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  • Patients with lung and colorectal cancer and limited financial reserves are more likely to have a higher symptom burden and a decreased quality of life.
  • Patients with lung and colorectal cancer and limited financial reserves are more likely to have a higher symptom burden and a decreased quality of life.
  • Results Among patients with lung and colorectal cancer, 40% and 33%, respectively, reported limited financial reserves.

The financial burden of cancer care differs significantly among ethnic and racial groups. These disparities negatively influence the quality of care, patient’s care experience, and outcomes in ethnic minority patients. These patients experience lower quality of care and life and greater symptom burden due to the financial strain. They also can less frequently afford the costs of medications and are forced into non-compliance. Black and Hispanic families earned a considerably lower median household income in the U.S. in 2014 (Figure 1).

 


These results were reported in The Journal of Clinical Oncology, Journal of Cancer Survivorship, and at a recent meeting of the American Association for Cancer Research (AACR).

"More than 1.6 million adults are diagnosed with cancer in the United States each year, and many face some form of financial hardship related to cancer and cancer treatment, even when they're insured," said study author Theresa Hastert, PhD, in a press release. Dr. Hastert is Assistant Professor in the Department of Oncology at Wayne State University School of Medicine and the Barbara Ann Karmanos Cancer Institute in Detroit. She presented these results at a recent meeting of AACR.

 

Figure 1. Median U.S. household income by ethnic group, 2014.
(1U.S. Census Bureau)

"In order to pay for cancer care, many patients experience changes to their financial situation that can include everything from cutting back on leisure spending to dipping into savings or selling assets, taking on debt, or even losing a home, or declaring bankruptcy," Dr. Hastert wrote.

Dr. Hastert reported results in 695 patients, including 414 black survivors. Overall, about 52% of the participants were facing some type of financial stress related to their treatment. That included that about 57% of blacks and 47% of whites. The study revealed that 31% of black patients went into debt for their treatment, compared to 18% of whites.

Black cancer survivors were also more likely to have made some treatment decisions based on cost concerns, such as avoiding an office visit or skipping doses of prescribed medicines. Such cost-cutting moves were made by 21% of black survivors, compared to about 15% of whites.

 

Non-small cell carcinoma of the lung. 

Journal of Clinical Oncology

A study published recently in the Journal of Clinical Oncology reported that patients with lung and colorectal cancer and limited financial reserves are more likely to have a higher symptom burden and a decreased quality of life. A clear dose-response relationship was present across all measures of well-being as correlated with decreasing financial reserves. These associations held for survivors reporting outcomes at 1 year and persisted after adjustment for stage, comorbidity, insurance, and other clinical attributes.

The Analysis

Patients participating in the Cancer Care Outcomes Research and Surveillance study were interviewed about their financial reserves, quality of life (QOL), and symptom burden at 4 months after diagnosis and, for survivors, at 12 months after diagnosis. The researchers examined the association between patient-reported financial reserves and patient-reported outcomes including the Brief Pain Inventory, symptom burden on the basis of the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire C30, and QOL on the basis of the EuroQoL-5 Dimension scale. Multivariable linear regression was used for each outcome and cancer type, adjusting for age, race/ethnicity, sex, income, insurance, stage at diagnosis, and comorbidity.

 

A model of lung cancer in situ.

“Results Among patients with lung and colorectal cancer, 40% and 33%, respectively, reported limited financial reserves (≤ 2 months). Relative to patients with more than 12 months of financial reserves, those with limited financial reserves reported significantly increased pain (adjusted mean difference, 5.03 [95% CI, 3.29 to 7.22] and 3.45 [95% CI, 1.25 to 5.66], respectively, for lung and colorectal), greater symptom burden (5.25 [95% CI, 3.29 to .22] and 5.31 [95% CI, 3.58 to 7.04]), and poorer QOL (4.70 [95% CI, 2.82 to 6.58] and 5.22 [95% CI, 3.61 to 6.82]),” the authors explained

Journal of Cancer Survivorship

Racial and ethnic disparities—specifically reduced financial resources—were linked to cost-related medication non-adherence (CRN) among cancer survivors in a study reported recently in the Journal of Cancer Survivorship. “Significant racial and ethnic disparities in CRN were evident among cancer survivors. Older African-American and Hispanic overall survivors were more likely to report CRN in the past year compared with non-Hispanic whites” the authors concluded. Cancer survivors are delaying or avoiding necessary care due to costs, and medication non-adherence is an important aspect of deferred treatment.

 


“In a nationally representative sample of 472,542 adults, 10,998 participants reported a history of cancer and 461,544 did not. Among 10,998 cancer survivors, 1397 (12.70 %) reported CRN. Among older cancer survivors, African-Americans were 2.64 times more likely (95 % confidence interval (CI), 1.73 to 4.01) and Hispanics 2.07 times more likely (95 % CI, 1.32 to 3.24) than whites to report CRN. Among younger cancer survivors, Hispanics were 1.61 times more likely (95 % CI, 1.23 to 2.10) than whites to report CRN,” the authors explained.

“Given increasing prescription drug expenditure, it is important to closely monitor CRN in high-risk subgroups. Racial and ethnic minority groups at high risk for CRN should be counseled on the importance of medication adherence and offered support services to promote medication adherence. Further studies are warranted to establish effective policies and interventions in vulnerable populations,” they concluded.


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