ABSTRACT
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.
Keywords
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Article Info
Publication History
Published online: June 12, 2018
Footnotes
Funding: None.
Conflict of Interest: AMG was an employee of Truven Health Analytics, an IBM Company at the time of submission of this work and is currently an employee of Vector Oncology, a Concerto HealthAI company. This work derives, in part, as an extension of AMG's PhD dissertation, completed at The University of Arizona.
Authorship: This endeavor represents original work which has not been previously published or presented and is not under consideration for publication elsewhere. All authors had access to the data and a role in writing the manuscript.
Identification
Copyright
© 2018 Published by Elsevier Inc.
