Most Advanced Colon Cancer Patients Experience Financial Hardship

Despite access to health insurance, most patients with metastatic colorectal cancer experienced financial problems due to their cancer treatment, according to a prospective cohort study.

The cumulative incidence of major financial hardship within the first 12 months after diagnosis was 71.3%, even though almost all patients had health insurance, reported Veena Shankaran, MD, of the University of Washington in Seattle, and colleagues.

Of the individual components that made up major financial hardship, the cumulative incidence for new debt was 57.6%, 26.6% for a ≥20% decline in income, 26.0% for new loans from family and friends, 3.4% for refinance of a home, and 2.6% for sale of a home.

“Given that 98% of the cohort had healthcare insurance, our findings can inform the national policy and payer discussion regarding health insurance and underinsurance in the United States,” Shankaran and colleagues wrote in the Journal of the National Cancer Institute.

“Additionally, interventions that help patients access assistance resources for non-medical costs, navigate employment benefits, and manage their other life expenses in the context of cancer diagnosis are needed,” they continued. “Given that financial hardships are experienced early and accumulate quickly during the first year after diagnosis, such interventions should be deployed at diagnosis and throughout the care continuum.”

Looking at potential predictors of major financial hardship, Shankaran and colleagues found that while there was no statistically significant differences based on age, race, income, or marital status, there was an association between greater hardship and income <$100,000 and total assets <$100,000.

There was no difference in the 12-month cumulative incidence of major financial hardship according to home ownership (69.9% for homeowners, and 71.8% for non-homeowners).

The point at which major financial hardship occurred varied, with cumulative incidence estimates of 24.9% at 3 months, 53.8% at 6 months, and 63.0% at 9 months. Patients experiencing hardship at 3 months reported reduced social functioning and quality of life at 6 months.

In order to improve cancer care delivery and patient outcomes, screening for financial hardship is critical, wrote K. Robin Yabroff, PhD, of the American Cancer Society in Atlanta, and colleagues in an editorial accompanying the study.

However, because many oncology practices use uninsurance as a screening tool, the majority of patients in this study would have been missed, they noted.

If the study’s results were extrapolated beyond metastatic colorectal cancer, they would demonstrate that financial hardship may be widespread among people diagnosed with cancer, including the approximately 1.9 million in the U.S. in 2021 alone, Yabroff and colleagues suggested.

“Future interventions and policy initiatives require rigorous research to assess these activities, whether practice-based screening and connection to resources or policies limiting out-of-pocket exposure, that ensure the remarkable advancements in cancer care are widely accessible without inflicting financial ruin for patients and their families,” they wrote.

These findings “draw attention to deficiencies in the United States healthcare system and economic safety nets that are unable to prevent the majority of cancer patients from experiencing financial hardship,” the authors concluded.

The study included 380 patients, 368 of whom were able to complete comprehensive financial and quality-of-life questionnaires; 73% were alive at the end of 1-year follow-up. Of those who died prior to completing the study, partial data were accessible, leaving 302 (82.1%) available for evaluation. Almost every participant in the study (98%) had health insurance.

Median age of the study participants was 60.2 years, with 63% under the age of 65. The majority (62%) were men, 13% were Black, 56% had a total household annual income ≤$50,000, and about 60% were employed in some capacity prior to diagnosis.