Death or Debt? National Estimates of Financial Toxicity in Persons with Newly-Diagnosed Cancer

被引:157
作者
Gilligan, Adrienne M. [1 ,2 ]
Alberts, David S. [3 ]
Roe, Denise J. [4 ]
Skrepnek, Grant H. [5 ,6 ]
机构
[1] Univ North Texas, Coll Pharm, Hlth Sci Ctr, Ft Worth, TX USA
[2] IBM Co, Truven Hlth Analyt, Houston, TX USA
[3] Univ Arizona, Canc Ctr, Tucson, AZ USA
[4] Univ Arizona, Mel & Enid Zuckerman Coll Publ Hlth, Tucson, AZ USA
[5] Univ Oklahoma, Hlth Sci Ctr, Coll Pharm, 1110 North Stonewall Ave, Oklahoma City, OK 73117 USA
[6] Univ Oklahoma, Hlth Sci Ctr, Peggy & Charles Stephenson Canc Ctr, Oklahoma City, OK 73117 USA
关键词
Bankruptcy; Cancer; Debt; Health and retirement study; Net worth; UNITED-STATES; ECONOMIC BURDEN; BREAST-CANCER; MEDICAL-CARE; NONADHERENCE; SURVIVORS; ADULTS; COSTS; INHIBITORS; MORTALITY;
D O I
10.1016/j.amjmed.2018.05.020
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
PURPOSE: The purpose of this study was to evaluate the impact of cancer upon a patient's net worth and debt in the US. METHODS: This longitudinal study used the Health and Retirement Study from 1998-2014. Persons >= 50 years with newly-diagnosed malignancies were included, excluding minor skin cancers. Multivariable generalized linear models assessed changes in net worth and debt (consumer, mortgage, home equity) at 2 and 4 years after diagnosis (year(+2), year(+4)), controlling for demographic and clinically-related variables, cancer-specific attributes, economic factors, and mortality. A 2-year period before cancer diagnosis served as a historical control. RESULTS: Across 9.5 million estimated new diagnoses of cancer from 2000-2012, individuals averaged 68.6 +/- 9.4 years with slight majorities being married (54.7%), not retired (51.1%), and Medicare beneficiaries (56.6%). At year(+2), 42.4% depleted their entire life's assets, with higher adjusted odds associated with worsening cancer, requirement of continued treatment, demographic and socioeconomic factors (ie, female, Medicaid, uninsured, retired, increasing age, income, and household size), and clinical characteristics (ie, current smoker, worse self-reported health, hypertension, diabetes, lung disease) (P<.05); average losses were $92,098. At year(+4), financial insolvency extended to 38.2%, with several consistent socioeconomic, cancer-related, and clinical characteristics remaining significant predictors of complete asset depletion. CONCLUSIONS: This nationally-representative investigation of an initially-estimated 9.5 million newly-diagnosed persons with cancer who were >= 50 years of age found a substantial proportion incurring financial toxicity. As large financial burdens have been found to adversely affect access to care and outcomes among cancer patients, the active development of approaches to mitigate these effects among already vulnerable groups remains of key importance. (C) 2018 Published by Elsevier Inc.
引用
收藏
页码:1187 / +
页数:18
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