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Survivors of Childhood Cancer Burdened With High Out-of-Pocket Medical Expenses

August 23, 2017

Childhood cancer survivors experience a higher percentage of income spent on out-of-pocket medical costs and issues that may jeopardize care or force a change of lifestyle, according to a report published in the Journal of Clinical Oncology (online August 17, 2017; doi:10.1200/JCO.2016.71.7066).


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Patients who survive childhood cancer often require long-term medical care, which leads to substantial financial burden. However, the extent of this burden has yet to be determined

Ryan D Nipp, MD, MPH, Massachusetts General Hospital, and colleagues conducted a study to measure financial burden in childhood survivors of cancer and to identify potential correlations between a higher percentage of income spent on out-of-pocket health care costs (≥ 10% of annual income) and issues relating to financial burden. Researchers surveyed an age-stratified, random sample of survivors of cancer (n = 580) and a sibling comparison group (n = 173) who were enrolled in the Childhood Cancer Survivor Study from May 2011 to April 2012. Respondents disclosed their household income, out-of-pocket medical costs, and issues related to financial burden such as jeopardizing care or changing lifestyle. Survey questions were adapted from various national surveys on financial burden.

Researchers utilized logistic regression to identify associations between respondent characteristics, a higher percentage of income spent on out-of-pocket medical costs, and financial burden.

Results of the survey showed that survivors of childhood cancer were significantly more likely to have out-of-pocket medical expenses of greater than or equal to 10% of their annual income (10.0% vs 2.9%, respectively; P < .001). Patient characteristics that contributed to this higher percentage included hospitalization within the past year (odds ratio [OR], 2.3; 95% CI, 1.1-4.9) and household income being less than $50,000 (OR, 5.5; 95% CI, 2.4-12.8).

Survivors of childhood cancer with a higher percentage of income spent on out-of-pocket medical expenses were faced with increased likelihood of issues paying medical bills (OR, 8.9; 95% CI, 4.4-18.0), deferring care for a medical concern (OR, 3.0; 95% CI, 1.6-5.9) skipping a treatment or follow-up (OR, 2.1; 95% CI, 1.1-4.0) and thoughts of filing for bankruptcy (OR, 6.6; 95% CI, 3.0-14.3).

Researchers concluded that survivors of childhood cancer are more likely to spend a higher percentage of their income on out-of-pocket medical expenses, which often influences their health-seeking behavior and health outcomes. “Our findings highlight the need to address financial burden in this population with long-term health care needs,” they wrote.—Zachary Bessette

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