Cancer's Financial Power Punch to Young Adults
In Dr Baker's study, the goal was to evaluate the potential impact of cancer and its accompanying treatment on employment and finances for young adult survivors. He and colleagues developed a cohort of young adult survivors between 18 and 39 years of age who were randomly selected from the tumor registries of seven academic institutions (LIVESTRONG Survivorship Centers of Excellence), and between 1 and 5 years from diagnosis.
Participants had to be at least 1 year from completion of active therapy but were still eligible if they were receiving maintenance treatment for the purpose of preventing recurrence. All patients had to have been treated with at least one of the following modalities: surgery, cytotoxic chemotherapy (74%), biological or targeted agents, and radiation therapy (40%). A proportion (20%) had been treated only with surgery.
A total of 875 young adult survivors (41% of attempted contacts) were enrolled and completed an online outcomes survey about to the effects of cancer and cancer treatment on employment, finances, and cancer-related distress. The largest proportion of patients (34.8%) received a diagnosis between 35 and 39 years of age, followed by 30-34 years of age (29.3%).
Breast cancer accounted for 27.7% (n = 242) of diagnoses, followed by endocrine cancers (15.2%; n = 133). Other diagnoses included lymphoma (13.4%), skin cancers (9.4%), genitourinary female cancers (5.7%), genitourinary male cancers (5.5%), leukemia (5.4%), brain and nervous system cancers (4.7%), cancer of the oral cavity and pharynx (2.7%), soft-tissue cancer (3%), and other types of cancer (3%).
The majority of participants reported being employed (84.4%) at some point between cancer diagnosis and study enrollment. Of those, 76% took extended paid time off.
Of participants who needed time off from work, the majority took less than 2 months off (40%), but 21% of patients required 6 months to 1 year of paid leave, 8% needed 1-3 years, and 2% more than 3 years.
A substantial proportion (39%) also had to take unpaid leave from their job. Within this group, 38% needed less than 2 months off, but one quarter of patients had to take between 2 and 6 months of leave without pay. More than one third (36%) had to take between 6 months and 3 years of unpaid leave, and 1.8% were out of work for more than 3 years.
Cancer in the Workplace
A cancer diagnosis also affected performance in the workplace. More than one half of the survivors participating in the survey reported that their impairments prohibited them from carrying out physical (59%) or mental (55%) tasks required for their job.
About two thirds reported that they believed that they were now less productive (67%), whereas 21% stated that they were not pursuing advancement or a promotion.
Finally, the financial impact of having cancer and subsequent treatment was also substantial in this population. More than one half of the group (61%) reported being "worried about medical bills," and 31% went into debt directly owing to their cancer treatment.
Of those incurring debt, one half of the survivors (53%) reported this amount to be under $10,000, whereas 29% reported debt in the range of $10,000-$24,999. However, some of the survivors stated that they had incurred far more substantial debt: 8.1% reported owing $25,000-$49,999, 5.2% owed $50,000-$74,999, 2.2% stated that they had incurred debt of $100,000 or more, and 4.8% filed for bankruptcy.
Unfortunately, Dr Baker noted, information about health insurance was limited in this survey, so it is unclear what proportion of the debt was attributed to medical bills that had to be paid out of pocket.
"We don't have the level of detail about insurance that we would have liked," he said. "And all of these patients were treated before implementation of the Affordable Care Act, so we don't know what effect that may have had."
About one third of respondents (36.7%) stated they "work to keep health insurance," whereas 39% reported being "concerned" about their health insurance.
Knowing the effect of the ACA on this population is important, Dr Baker explained. "If it has improved healthcare access for these patients, that will hopefully lessen the financial toxicity that they will be experiencing in the future," he said. "We will need to look at that, and see whether it has changed access and reduced expenses for this population."
Medscape Oncology © 2016 WebMD, LLC
Any views expressed above are the author's own and do not necessarily reflect the views of WebMD or Medscape.
Cite this: Young Adult Cancer Survivors Hard Hit by Treatment Costs - Medscape - Mar 31, 2016.