Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Journal of Cancer Survivorship
Published in: Journal of Cancer Survivorship 3/2019

01-06-2019 | Care

The social and economic toll of cancer survivorship: a complex web of financial sacrifice

Authors: Matthew P. Banegas, Jennifer L. Schneider, Alison J. Firemark, John F. Dickerson, Erin E. Kent, Janet S. de Moor, Katherine S. Virgo, Gery P. Guy Jr, Donatus U. Ekwueme, Zhiyuan Zheng, Alexandra M. Varga, Lisa A. Waiwaiole, Stephanie M. Nutt, Aditi Narayan, K. Robin Yabroff

Published in: Journal of Cancer Survivorship | Issue 3/2019

Login to get access

Abstract

Purpose

To assess the financial outcomes and associated social and economic effects on cancer survivors and their families.

Methods

We assessed the responses of 1656 cancer survivors to a survey with both closed- and open-ended questions about cancer-related financial sacrifices they and their family experienced and evaluated differences in financial sacrifice by reported levels of cancer-related debt.

Results

The most commonly reported financial sacrifices included cutbacks on household budgets, challenges with health care insurance and costs, career/self-advancement constraints, reduction/depletion of assets, and inability to pay bills. Survivors who incurred $10,000 or more in debt were significantly more likely to report social and economic impacts, including housing concerns and strained relationships.

Conclusions

Our analysis demonstrates both the frequency with which cancer survivors and families must make financial sacrifices as a result of their cancer, and the variety of forms that this sacrifice can take, even for individuals who have health insurance. The many types of financial hardship create challenges that are unique to each survivor and family.

Implications for Cancer Survivors

Interventions that allow for personalized assistance with the specific financial and social needs of cancer survivors and their families have the potential to address a critical aspect of the long-term wellbeing of this important population.
Appendix
Available only for authorised users
Literature
1.
American Cancer Society. Cancer treatment & survivorship facts & figures 2016-2017. Atlanta: American Cancer Society; 2016.
2.
Shih YC, Smieliauskas F, Geynisman DM, Kelly RJ, Smith TJ. Trends in the cost and use of targeted cancer therapies for the privately insured nonelderly: 2001 to 2011. J Clin Oncol. 2015;33(19):2190–6.CrossRef
3.
Shih YT, Xu Y, Liu L, Smieliauskas F. Rising prices of targeted oral anticancer medications and associated financial burden on Medicare beneficiaries. J Clin Oncol. 2017 Aug 1;35(22):2482–2489.
4.
Bennette CS, Richards C, Sullivan SD, Ramsey SD. Steady increase in prices for oral anticancer drugs after market launch suggests a lack of competitive pressure. Health Aff (Millwood). 2016;35(5):805–12.CrossRef
5.
Dusetzina SB. Drug pricing trends for orally administered anticancer medications reimbursed by commercial health plans, 2000-2014. JAMA Oncol. 2016;2(7):960–1.CrossRef
6.
7.
Peppercorn J. Financial toxicity and societal costs of cancer care: distinct problems require distinct solutions. Oncologist. 2017;22(2):123–5.CrossRef
8.
Altice CK, Banegas MP, Tucker-Seeley RD, Yabroff KR. Financial hardships experienced by cancer survivors: a systematic review. J Natl Cancer Inst. 2017;109(2):djw205.CrossRef
9.
Yabroff KR, Dowling EC, Guy GP Jr, Banegas MP, Davidoff A, Han X, et al. Financial hardship associated with cancer in the United States: findings from a population-based sample of adult cancer survivors. J Clin Oncol. 2016;34(3):259–67.CrossRef
10.
Pisu M, Kenzik KM, Oster RA, Drentea P, Ashing KT, Fouad M, et al. Economic hardship of minority and non-minority cancer survivors 1 year after diagnosis: another long-term effect of cancer? Cancer. 2015;121(8):1257–64.CrossRef
11.
Regenbogen SE, Veenstra CM, Hawley ST, Banerjee M, Ward KC, Kato I, et al. The personal financial burden of complications after colorectal cancer surgery. Cancer. 2014;120(19):3074–81.CrossRef
12.
Zafar SY, Peppercorn JM, Schrag D, Taylor DH, Goetzinger AM, Zhong X, et al. The financial toxicity of cancer treatment: a pilot study assessing out-of-pocket expenses and the insured cancer patient's experience. Oncologist. 2013;18(4):381–90.CrossRef
13.
Bestvina CM, Zullig LL, Rushing C, Chino F, Samsa GP, Altomare I, et al. Patient-oncologist cost communication, financial distress, and medication adherence. J Oncol Pract. 2014;10(3):162–7.CrossRef
14.
Kent EE, Forsythe LP, Yabroff KR, Weaver KE, de Moor JS, Rodriguez JL, et al. Are survivors who report cancer-related financial problems more likely to forgo or delay medical care? Cancer. 2013;119(20):3710–7.CrossRef
15.
Davidoff AJ, Hill SC, Bernard D, Yabroff KR. The affordable care act and expanded insurance eligibility among nonelderly adult cancer survivors. J Natl Cancer Inst. 2015;107(9):djv181.CrossRef
16.
Sharp L, Timmons A. Pre-diagnosis employment status and financial circumstances predict cancer-related financial stress and strain among breast and prostate cancer survivors. Support Care Cancer. 2016;24(2):699–709.CrossRef
17.
Sharp L, O'Leary E, O'Ceilleachair A, Skally M, Hanly P. Financial impact of colorectal cancer and its consequences: associations between cancer-related financial stress and strain and health-related quality of life. Dis Colon Rectum. 2018;61(1):27–35.CrossRef
18.
Sharp L, Carsin AE, Timmons A. Associations between cancer-related financial stress and strain and psychological well-being among individuals living with cancer. Psychooncology. 2013;22(4):745–55.CrossRef
19.
Group AS, Kimman M, Jan S, Yip CH, Thabrany H, Peters SA, et al. Catastrophic health expenditure and 12-month mortality associated with cancer in Southeast Asia: results from a longitudinal study in eight countries. BMC Med. 2015;13:190.CrossRef
20.
Group AS, Jan S, Kimman M, Peters SA, Woodward M. Financial catastrophe, treatment discontinuation and death associated with surgically operable cancer in South-East Asia: results from the ACTION study. Surgery. 2015;157(6):971–82.CrossRef
21.
Chan A, Chiang YY, Low XH, Yap KY, Ng R. Affordability of cancer treatment for aging cancer patients in Singapore: an analysis of health, lifestyle, and financial burden. Support Care Cancer. 2013;21(12):3509–17.CrossRef
22.
Lauzier S, Levesque P, Mondor M, Drolet M, Coyle D, Brisson J, et al. Out-of-pocket costs in the year after early breast cancer among Canadian women and spouses. J Natl Cancer Inst. 2013;105(4):280–92.CrossRef
23.
de Oliveira C, Bremner KE, Ni A, Alibhai SM, Laporte A, Krahn MD. Patient time and out-of-pocket costs for long-term prostate cancer survivors in Ontario, Canada. J Cancer Surviv. 2014;8(1):9–20.CrossRef
24.
Ekwueme DU, Yabroff KR, Guy GP Jr, Banegas MP, de Moor JS, Li C, et al. Medical costs and productivity losses of cancer survivors--United States, 2008-2011. MMWR Morb Mortal Wkly Rep. 2014;63(23):505–10.PubMedPubMedCentral
25.
LIVESTRONG Foundation. Survivors’ experiences with employment. Austin: LIVESTRONG Foundation; 2013.
26.
Zheng Z, Yabroff KR, Guy GP Jr, Han X, Li C, Banegas MP, et al. Annual medical expenditure and productivity loss among colorectal, female breast, and prostate cancer survivors in the United States. J Natl Cancer Inst. 2016;108(5):djv382.CrossRef
27.
Parsons HM, Schmidt S, Harlan LC, Kent EE, Lynch CF, Smith AW, et al. Young and uninsured: insurance patterns of recently diagnosed adolescent and young adult cancer survivors in the AYA HOPE study. Cancer. 2014;120(15):2352–60.CrossRef
28.
Gordon LG, Walker SM, Mervin MC, Lowe A, Smith DP, Gardiner RA, et al. Financial toxicity: a potential side effect of prostate cancer treatment among Australian men. Eur J Cancer Care (Engl). 2017;26(1):e12392.CrossRef
29.
Mahal A, Karan A, Fan VY, Engelgau M. The economic burden of cancers on Indian households. PLoS One. 2013;8(8):e71853.CrossRef
30.
31.
Advani PS, Reitzel LR, Nguyen NT, Fisher FD, Savoy EJ, Cuevas AG, et al. Financial strain and cancer risk behaviors among African Americans. Cancer Epidemiol Biomark Prev. 2014;23(6):967–75.CrossRef
32.
Meeker CR, Geynisman DM, Egleston BL, Hall MJ, Mechanic KY, Bilusic M, et al. Relationships among financial distress, emotional distress, and overall distress in insured patients with cancer. J Oncol Pract. 2016;12(7):e755–64.CrossRef
33.
Ceilleachair AO, Costello L, Finn C, Timmons A, Fitzpatrick P, Kapur K, et al. Inter-relationships between the economic and emotional consequences of colorectal cancer for patients and their families: a qualitative study. BMC Gastroenterol. 2012;12:62.CrossRef
34.
Ponnet K. Financial stress, parent functioning and adolescent problem behavior: an actor-partner interdependence approach to family stress processes in low-, middle-, and high-income families. J Youth Adolesc. 2014;43(10):1752–69.CrossRef
35.
Stepanikova I, Powroznik K, Cook KS, Tierney DK, Laport GG. Exploring long-term cancer survivors' experiences in the career and financial domains: interviews with hematopoietic stem cell transplantation recipients. J Psychosoc Oncol. 2016;34(1–2):2–27.CrossRef
36.
Moffatt S, Noble E, White M. Addressing the financial consequences of cancer: qualitative evaluation of a welfare rights advice service. PLoS One. 2012;7(8):e42979.CrossRef
37.
de Souza JA, Wong YN. Financial distress in cancer patients. J Med Person. 2013;11(2):73–7.CrossRef
38.
39.
Yabroff KR, Dowling E, Rodriguez J, Ekwueme DU, Meissner H, Soni A, et al. The medical expenditure panel survey (MEPS) experiences with cancer survivorship supplement. J Cancer Surviv. 2012;6(4):407–19.CrossRef
40.
41.
Corbin J, Strauss A, editors. Basics of qualitative research: techniques and procedures for developing grounded theory. 3rd ed. Thousand Oaks: Sage Publication, Inc.; 2008.
42.
Patton MQ, editor. Qualitative research & evaluation methods. 3rd ed. Thousand Oaks: Sage Publications, Inc.; 2002.
43.
Bernard HR, Wutich AY, Ryan GW, editors. Analyzing qualitative data: systematic approaches. 2nd ed. Thousand Oaks: Sage Publications, Inc.; 2017.
44.
Office of the Assistant Secretary for Planning and Evaluation. Report to congress: social risk factors and performance under Medicare’s value-based payment programs. Washington, D.C.: U.S. Department of Health and Human Services December; 2016. p. 21.
45.
Banegas MP, Guy GP Jr, de Moor JS, Ekwueme DU, Virgo KS, Kent EE, et al. For working-age cancer survivors, medical debt and bankruptcy create financial hardships. Health Aff (Millwood). 2016;35(1):54–61.CrossRef
46.
Kent EE, Davidoff A, de Moor JS, McNeel TS, Virgo KS, Coughlan D, et al. Impact of sociodemographic characteristics on underemployment in a longitudinal, nationally representative study of cancer survivors: evidence for the importance of gender and marital status. J Psychosoc Oncol. 2018;36(3):287–303.CrossRef
47.
Kirchhoff AC, Nipp R, Warner EL, Kuhlthau K, Leisenring WM, Donelan K, et al. “Job lock” among long-term survivors of childhood cancer: a report from the Childhood Cancer Survivor Study. JAMA Oncol. 2018;4(5):707–11.CrossRef
48.
Chino F, Peppercorn J, Taylor DH Jr, Lu Y, Samsa G, Abernethy AP, et al. Self-reported financial burden and satisfaction with care among patients with cancer. Oncologist. 2014;19(4):414–20.CrossRef
49.
Ell K, Xie B, Wells A, Nedjat-Haiem F, Lee PJ, Vourlekis B. Economic stress among low-income women with cancer: effects on quality of life. Cancer. 2008;112(3):616–25.CrossRef
50.
Stump TK, Eghan N, Egleston BL, Hamilton O, Pirollo M, Schwartz SJ, et al. Cost concerns of patients with cancer. J Oncol Pract. 2013;9(5):251–7.CrossRef
51.
Banegas MP, Dickerson JF, Kent EE, de Moor JS, Virgo KS, Guy GP Jr, et al. Exploring barriers to the receipt of necessary medical care among cancer survivors under age 65 years. J Cancer Surviv. 2018;12(1):28–37.CrossRef
52.
Zheng Z, Han X, Guy GP Jr, Davidoff AJ, Li C, Banegas MP, et al. Do cancer survivors change their prescription drug use for financial reasons? Findings from a nationally representative sample in the United States. Cancer. 2017;123(8):1453–63.CrossRef
53.
Zullig LL, Peppercorn JM, Schrag D, Taylor DH, Lu Y, Samsa G. Financial distress, use of cost-coping strategies, and adherence to prescription medication among patients with Cancer. J Oncol Pract. 2013;9(6 SUPPL):60s–3s.CrossRef
54.
Chino F, Peppercorn JM, Rushing C, Kamal AH, Altomare I, Samsa G, et al. Out-of-pocket costs, financial distress, and underinsurance in cancer care. JAMA Oncol. 2017;3(11):1582–4.CrossRef
55.
Shankaran V, Ramsey S. Addressing the financial burden of cancer treatment; From Copay to Can't Pay. JAMA Oncol. 2015;1(3):273–4.CrossRef
56.
Sturgeon JA, Arewasikporn A, Okun MA, Davis MC, Ong AD, Zautra AJ. The psychosocial context of financial stress: implications for inflammation and psychological health. Psychosom Med. 2016;78(2):134–43.CrossRef
57.
Banegas MP, Dickerson JF, Friedman NL, Mosen DM, Ender AX, Chang TR, et al. Evaluation of a novel financial navigator pilot to address patient concerns about medical care costs. Perm J. 2019;23:18–084.PubMedPubMedCentral
58.
Shankaran V, Leahy T, Steelquist J, Watabayashi K, Linden H, Ramsey S, et al. Pilot feasibility study of an oncology financial navigation program. J Oncol Pract. 2018;14(2):e122–e9.CrossRef
59.
Yezefski T, Steelquist J, Watabayashi K, Sherman D, Shankaran V. Impact of trained oncology financial navigators on patient out-of-pocket spending. Am J Manag Care. 2018;24(5 Suppl):S74–S9.PubMed
60.
Tucker-Seeley RD, Yabroff KR. Minimizing the “financial toxicity” associated with cancer care: advancing the research agenda. J Natl Cancer Inst. 2016;108(5):djv410.CrossRef
Metadata
Title
The social and economic toll of cancer survivorship: a complex web of financial sacrifice
Authors
Matthew P. Banegas
Jennifer L. Schneider
Alison J. Firemark
John F. Dickerson
Erin E. Kent
Janet S. de Moor
Katherine S. Virgo
Gery P. Guy Jr
Donatus U. Ekwueme
Zhiyuan Zheng
Alexandra M. Varga
Lisa A. Waiwaiole
Stephanie M. Nutt
Aditi Narayan
K. Robin Yabroff
Publication date
01-06-2019
Publisher
Springer US
Keyword
Care
Published in
Journal of Cancer Survivorship / Issue 3/2019
Print ISSN: 1932-2259
Electronic ISSN: 1932-2267
DOI
https://doi.org/10.1007/s11764-019-00761-1

Other articles of this Issue 3/2019

Journal of Cancer Survivorship 3/2019 Go to the issue

Review

Health care services use among long-term breast cancer survivors: a systematic review

Review

Clinical ascertainment of health outcomes in Asian survivors of childhood cancer: a systematic review

OriginalPaper

Use of complementary/integrative methods: cancer survivors’ misconceptions about recurrence prevention

OriginalPaper

Breast cancer survivors reduce accelerometer-measured sedentary time in an exercise intervention

OriginalPaper

Socioeconomic disparities in health-related quality of life among colorectal cancer survivors

OriginalPaper

Prescribing fitness apps for people with cancer: a preliminary assessment of content and quality of commercially available apps
Webinar | 19-02-2024 | 17:30 (CET)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer

Watch now

Antibody–drug conjugates (ADCs) are novel agents that have shown promise across multiple tumor types. Explore the current landscape of ADCs in breast and lung cancer with our experts, and gain insights into the mechanism of action, key clinical trials data, existing challenges, and future directions.

Dr. Véronique Diéras
Prof. Fabrice Barlesi
Developed by: Springer Medicine
Image Credits