Survivors of Three Common Cancers Face High Economic Burden

Roxanne Nelson, BSN, RN

January 07, 2016

The economic impact of having cancer continues even when patients become survivors. In the United States, not only do cancer survivors have annual expenditures in excess of thousands of dollars, the economic burden associated with cancer varies by cancer site and age, according to a new study.

The annual economic burden, as well as annual excess medical expenditures, specifically among survivors of breast, colorectal, and prostate cancers, were examined by Zhiyuan Zheng, PhD, senior health services researcher in the surveillance and health services research program at the American Cancer Society, and his colleagues.

The study was published online on December 24, 2015, in the Journal of the National Cancer Institute.

The researchers defined total economic annual burden as direct medical expenditures plus productivity losses (employment disability, missed work days, and days spent in bed). For individuals described as "nonelderly" (18 to 64 years), colorectal cancer was associated with the highest annual costs ($20,219), followed by breast cancer ($14,167) and prostate cancer ($9280).

In the elderly population, defined as those 65 years and older, the total economic burden of colorectal cancer was highest ($19,051), followed by prostate cancer ($16,851) and breast cancer ($14,391). The researchers also evaluated excess economic burden, consisting of adjusted annual medical expenditures and productivity losses associated with cancer, faced by cancer survivors and those without a history of cancer.

For nonelderly survivors, annual excess expenditures were $8657 for colorectal cancer, $5119 for breast cancer, and $3586 for prostate cancer. For elderly survivors, annual excess expenditures were $4913 for colorectal cancer, $2288 for breast cancer, and $3524 for prostate cancer.

In the nonelderly cohort, colorectal and breast cancer survivors were more likely to receive employment disability and have to contend with lost productivity in the workplace (7.2 days) and at home (4.5 days). In contrast, in the elderly cohort, productivity losses in survivors were comparable to those in people without a history of cancer for all three cancer sites.

"The high excess burden among working-age cancer survivors is likely related to being unable to work due to illness," Dr Zheng told Medscape Medical News. "This will result in loss of income and insurance. And family members might have to sacrifice their working time to take care of cancer survivors."

"There is also evidence that younger cancer survivors are more likely to file personal bankruptcy because of accumulated debt," he added. "This is an area that requires more effort in the future."

"This study helps us quantify the excess economic burden associated with the three major cancer sites," said Dr Zheng. "From a policy perspective, the alternative payment models of the Affordable Care Act might play an important role in reducing the financial burden and improving the quality of care. I think cancer survivorship programs should also make efforts to identify cancer survivors who are at risk of extremely high financial burden."

Three Most Prevalent Cancers

An estimated 14.5 million people with a history of cancer were alive in the United States in 2014. This is projected to increase because of growth and aging.

The Centers for Disease Control and Prevention reported that the mean annual medical expenditures for male survivors of all cancers was $8091 in 2014, compared with $3094 for those without a cancer history, as previously reported by Medscape Medical News. It was similar for women: $8412 for cancer survivors and $5119 for those without a cancer history. In addition to out-of-pocket costs, men with a history of cancer lost an estimated $3700 in annual productivity, and women lost an estimated $4000.

Details of the way these expenses vary by cancer type have been lacking, until now.

In their study, Dr Zheng and his colleagues used Medical Expenditure Panel Survey data from the 2008 to 2012 to measure the excess economic burden attributable to the three most prevalent cancers reported in the United States. They analyzed annual medical expenditures and productivity loses for 540 survivors of colorectal cancer, 1568 survivors of female breast cancer, 1170 survivors of prostate cancer, and 109,423 people without a history of cancer.

The data were stratified by cancer site and age, and controlled for age, sex, race/ethnicity, marital status, education, number of comorbidities, and geographic region.

For all three cancer sites, nonelderly and elderly cancer survivors were more likely to be older, to be non-Hispanic white, and to have more comorbid conditions.

Nonelderly colorectal cancer survivors were more likely to receive cancer-related treatment in the 2 years after diagnosis than elderly colorectal cancer survivors (84.9% vs 52.4%). In contrast, nonelderly prostate cancer survivors were less likely to receive cancer-related treatment in the 2 years after diagnosis than elderly prostate cancer survivors (27.2% vs 43.2%).

Some cancer survivors will forgo necessary care because of cost, Dr Zheng noted, and some will delay or skip their prescription medications, in part because of the high cost of cancer drugs.

"The pricing of cancer drugs or reimbursement of cancer drugs should be evidence-based," he said. "Future efforts should focus on pricing models based on treatment outcomes, such as overall survival. The cost of cancer drugs should be within a reasonable cost-effectiveness threshold, but also affordable for the whole population if it is included in the healthcare system."

J Natl Cancer Inst. Published online December 24, 2015. Abstract

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