In the Journals

Financial burden linked to depression in cancer survivors

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March 14, 2016

Cancer survivors with a high disease-related financial burden appeared more susceptible to depression, poor quality of life and fear of recurrence, according to the results of cross-sectional study.

“The cost of cancer care is extremely high, and it is escalating every year,” Hrishikesh P. Kale, MS, a doctoral candidate in pharmacoecomonics and health outcomes at Virginia Commonwealth University School of Pharmacy, told HemOnc Today. “Along with high medical expenses, cancer survivors face problems such as loss of employment and reduced productivity. It has been well-established in the literature that because of high out-of-pocket costs, many cancer survivors forgo or delay medical care and mental health-related services and avoid filling prescriptions. This puts their physical and mental health at risk.”

Other studies have shown that cancer survivors are at greater risk for bankruptcy than the general population.

Kale and Norman V. Carroll, PhD, professor of pharmacy administration at Virginia Commonwealth University School of Pharmacy, analyzed data from 19.6 million cancer survivors who completed the 2011 Medical Expenditure Panel Survey — which included a self-reported patient questionnaire — to determine whether a link existed between cancer-related financial hardship and health-related quality of life.

Kale and Carroll considered respondents to be financially burdened if they reported borrowing money or declaring bankruptcy; worried about how they would pay large medical bills; were unable to pay the costs of medical care visits; or reported making other financial sacrifices.

Researchers evaluated respondents’ quality of life using the Physical Component Score (PCS) and Mental Component Score (MCS) of the 12-Item Short-Form Health Survey. They also evaluated data on depressed mood, psychological distress and fear of cancer recurrence.

Overall, 28.7% of the survivors reported experiencing financial burden in at least one area specified by the researchers (one financial problem, 15.8%; two financial problems, 7.2%; three financial problems, 4.1%; four financial problems, 1.5%).

A total of 7.6% of cancer survivors reported borrowing money; 4.2% reported borrowing less than $10,000, whereas 3% reported that they borrowed $10,000 or more. Further, 1.4% filed for bankruptcy.

Additionally, 20.9% of patients reported that they worried about how they would pay large medical bills, and 11.5% reported that they could not pay for medical care visits. Other financial sacrifices were reported by 8.6% of survivors.

Survivors who reported at least one financial problem had lower average PCS (42.3 vs. 44.9) and MCS (48.1 vs. 52.1) than those who did not.

Results of adjusted analyses showed survivors with financial burden had significantly lower PCS (beta = –2.45; 95% CI, –3.75 to –1.15) and MCS (beta = –3.05; 95% CI, –4.42 to –1.67). This association appeared especially apparently among survivors with three or more financial problems (PCS, beta = – 6.15; 95% CI, –8.99 to –3.31; MCS, beta - –7.13; 95 %CI, –10.84 to –3.42).

A greater proportion of survivors with financial burdens worried about a cancer recurrence (69% vs. 35%) and worried about how a recurrence would affect their responsibilities (70% vs. 38%).

Forty-five percent of survivors in financial distress perceived a greater possibility of cancer recurrence within 10 years, compared with 24% of survivors who did not report hardships.

Further, survivors with financial hardships were more likely to experience depressed moods (OR = 1.95; 95% CI, 1.29-2.95) and psychological distress (OR = 1.75; 95% CI, 0.99-3.08) — especially those reporting three or more hardships (depressed mood, OR = 3.41; psychological distress, OR = 2.56).

Kale and Carroll acknowledged study limitations, including their inability to establish causality due to the cross-sectional design. Further, because the Medical Expenditure Panel Survey did not record data on cancer stage, they were unable to control for its effect on outcomes.

“Our results suggest that policies and practices that minimize the out-of-pocket expenses incurred by patients with cancer can improve the long-term health-related quality of life and psychological health of survivors,” Kale said. “This suggests a need for studies that assess the effectiveness of value-based reimbursement, clinical practice guidelines and patient–physician communication in reducing the cost of cancer care. Oncologists, clinical pharmacists and other health care providers can increase the extent to which they consider selecting treatments that are less expensive but similar in effectiveness, discussing treatment costs with patients, and involving patients in making decisions about their therapy.” – by Cameron Kelsall

For more information:

Hrishikesh P. Kale, MS, can be reached at kaleh@vcu.edu.

Disclosure: Kale and Carroll report no relevant financial disclosures.