Data shows cancer patients forego preventative care, use EDs more often
Monday, June 29, 2020
Cancer patients with financial hardships are more likely to forego preventative care and are therefore more likely to seek care for pain, urinary tract infections, respiratory distress and other ailments in an emergency department.
That's the result of a data analysis of more than 10,000 cancer survivors who responded to the National Health Interview Survey (2013-17).
"We think that the complexity of care needs for cancer patients with preexisting comorbid conditions may cause a shift in the attention of providers and patients away from comorbid disease management to focus on the cancer treatment," said lead author Jason Zheng, Ph.D. "It is likely that cancer survivors with financial hardship may delay or forgo other care, including primary or specialty care, to save money and only focus on surviving cancer. Therefore, they are more likely to end up in the ED."
While most of those who participated in the study had some form of health insurance, patients struggle to pay coinsurance, deductibles, copayments, and other out-of-pocket expenses, Zheng said.
"Many have difficulties in making all of these copayments," said Zheng, a health economist and a principal scientist in the Surveillance and Health Services Research Program at the American Cancer Society (ACS). "In our modeling, we controlled for health insurance throughout all the adjusted analyses, but we still find that it is common for cancer survivors to report both medical and nonmedical financial hardship."
The analysis created four levels of medical financial hardship intensities and five levels of nonmedical financial hardship intensities that included measures for food insecurity and worry about other economic needs. Overall, cancer patients with higher medical financial hardship intensity visited the ED more often.
Those with higher medical financial hardship intensities were also less likely to access routine preventative care such as flu vaccines and breast cancer screenings.
"It is possible that patients with higher socioeconomic status are more aware of the elimination of cost-sharing for preventive services, and this is related to health insurance literacy," he said. "Moreover, low health literacy may also play an important role, because it was consistently associated with lower receipt of mammography screening and influenza vaccine."
Indeed, cancer patients are known to experience a higher amount of "financial toxicity" related to their treatment. A 2017 study found 39% of cancer patients experienced a greater financial burden than they anticipated and 16% reported high or overwhelming financial distress.
Scholars attribute the financial burden of cancer care to several factors. Private insurance premiums increased by 170% from 1999 to 2011. The introduction of tiered formularies caused prescription drug copayments to transfer more cost to patients.
"The sad story of all of this is that the ones with chronic health conditions are the ones who need care the most, and they are the ones most likely to skip some of their needed healthcare," said Dr. Douglas Fair, a pediatric oncologist at the University of Utah in Salt Lake City. "This may be because they also have more social morbidities. They may not have a job or not have insurance because they don't have a job, so again, they are socioeconomically vulnerable."
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