Financial burden in survivors of childhood cancer: A report from the Childhood Cancer Survivor Study Journal Article


Authors: Nipp, R. D.; Kirchhoff, A. C.; Fair, D.; Rabin, J.; Hyland, K. A.; Kuhlthau, K.; Perez, G. K.; Robison, L. L.; Armstrong, G. T.; Nathan, P. C.; Oeffinger, K. C.; Leisenring, W. M.; Park, E. R.
Article Title: Financial burden in survivors of childhood cancer: A report from the Childhood Cancer Survivor Study
Abstract: Purpose Survivors of childhood cancer may experience financial burden as a result of health care costs, particularly because these patients often require long-term medical care. We sought to evaluate the prevalence of financial burden and identify associations between a higher percentage of income spent on out-of-pocket medical costs ($ 10% of annual income) and issues related to financial burden (jeopardizing care or changing lifestyle) among survivors of childhood cancer and a sibling comparison group. Methods Between May 2011 and April 2012, we surveyed an age-stratified, random sample of survivors of childhood cancer and a sibling comparison group who were enrolled in the Childhood Cancer Survivor Study. Participants reported their household income, out-of-pocket medical costs, and issues related to financial burden (questions were adapted from national surveys on financial burden). Logistic regression identified associations between participant characteristics, a higher percentage of income spent on out-of-pocket medical costs, and financial burden, adjusting for potential confounders. Results Among 580 survivors of childhood cancer and 173 siblings, survivors of childhood cancer were more likely to have out-of-pocket medical costs $ 10% of annual income (10.0% v 2.9%; P, .001). Characteristics of the survivors of childhood cancer that were associated with a higher percentage of income spent on out-of-pocket costs included hospitalization in the past year (odds ratio [OR], 2.3; 95% CI, 1.1 to 4.9) and household income, $50,000 (OR, 5.5; 95% CI, 2.4 to 12.8). Among survivors of childhood cancer, a higher percentage of income spent on out-of-pocket medical costs was significantly associated with problems paying medical bills (OR, 8.9; 95% CI, 4.4 to 18.0); deferring care for a medical problem (OR, 3.0; 95% CI, 1.6 to 5.9); skipping a test, treatment, or follow-up (OR, 2.1; 95% CI, 1.1 to 4.0); and thoughts of filing for bankruptcy (OR, 6.6; 95% CI, 3.0 to 14.3). Conclusion Survivors of childhood cancer are more likely to report spending a higher percentage of their income on out-of-pocket medical costs, which may influence their health-seeking behavior and potentially affect health outcomes. Our findings highlight the need to address financial burden in this population with long-term health care needs. © 2017 American Society of Clinical Oncology. All rights reserved.
Keywords: adult; child; middle aged; young adult; major clinical study; neoplasms; logistic models; prevalence; health survey; childhood cancer; survivor; cancer survivor; self report; siblings; survivors; financial management; health care cost; health insurance; medicaid; economics; health expenditures; insurance; cross-sectional study; cross-sectional studies; sibling; marriage; health care costs; statistical model; cost of illness; treatment refusal; hospitalization cost; health care access; income; insurance, health; health surveys; procedures; insurance coverage; self medication; disease burden; humans; human; male; female; priority journal; article; statistics and numerical data; financial deficit; household income
Journal Title: Journal of Clinical Oncology
Volume: 35
Issue: 30
ISSN: 0732-183X
Publisher: American Society of Clinical Oncology  
Date Published: 2017-10-20
Start Page: 3474
End Page: 3481
Language: English
DOI: 10.1200/jco.2016.71.7066
PUBMED: 28817372
PROVIDER: scopus
PMCID: PMC5648170
DOI/URL:
Notes: Article -- Export Date: 4 December 2017 -- Source: Scopus
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  1. Kevin Oeffinger
    248 Oeffinger