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Background: This study examines patients' understanding of health insurance terms and concepts and quantifies health insurance literacy (HIL) levels by key sociodemographic factors. Methods: This study included 393 adult patients with cancer (>18 years old) receiving treatment in two ambulatory infusion centers: Mayo Clinic in Phoenix, Arizona and the University of Mississippi Medical Center in Jackson, Mississippi. Respondents' perceptions of their HIL were assessed using the Health Insurance Literacy Measure (HILM), a validated 21‐item measure of a consumer's ability to select and use health insurance (HIL self‐efficacy). Respondents' knowledge of health insurance concepts (HIL knowledge) was measured using 10 items created by the Kaiser Family Foundation. The number of correct answers was categorized into three levels: 0–4 (low knowledge), 5–6 (moderate knowledge), and 7–10 (high knowledge). Multivariable logistic regressions were used to compare correct answers to HIL knowledge questions by HIL self‐efficacy. Results: Nearly three‐quarters of patients had high HIL self‐efficacy and high HIL knowledge (70.5%), understanding basic insurance terms, such as premiums and deductibles. Relatively low percentages of patients correctly answered questions about the meaning of provider networks, health insurance formularies, and calculating out‐of‐pocket spending in scenarios when insurers pay a portion of allowed charges. Lower HIL knowledge was more common among patients with less educational attainment (

Background: Costs of cancer care can result in patient financial hardship; many professional organizations recommend provider discussions about treatment costs as part of high‐quality care. In this pilot study, the authors examined patient–provider cost discussions documented in the medical records of individuals who were diagnosed with advanced non–small cell lung cancer (NSCLC) and melanoma—cancers with recently approved, high‐cost treatment options. Methods: Individuals who were newly diagnosed in 2017–2018 with stage III/IV NSCLC (n = 1767) and in 2018 with stage III/IV melanoma (n = 689) from 12 Surveillance, Epidemiology, and End Results regions were randomly selected for the National Cancer Institute Patterns of Care Study. Documentation of cost discussions was abstracted from the medical record. The authors examined patient, treatment, and hospital factors associated with cost discussions in multivariable logistic regression analyses. Results: Cost discussions were documented in the medical records of 20.3% of patients with NSCLC and in 24.0% of those with melanoma. In adjusted analyses, privately insured (vs. publicly insured) patients were less likely to have documented cost discussions (odds ratio [OR], 0.54; 95% confidence interval [CI], 0.37–0.80). Patients who did not receive systemic therapy or did not receive any cancer‐directed treatment were less likely to have documented cost discussions than those who did receive systemic therapy (OR, 0.39 [95% CI, 0.19–0.81] and 0.46 [95% CI, 0.30–0.70], respectively), as were patients who were treated at hospitals without residency programs (OR, 0.64; 95% CI, 0.42–0.98). Conclusions: Cost discussions were infrequently documented in the medical records of patients who were diagnosed with advanced NSCLC and melanoma, which may hinder identifying patient needs and tracking outcomes of associated referrals. Efforts to increase cost‐of‐care discussions and relevant referrals, as well as their documentation, are warranted. The authors examined patient–provider cost discussions documented in the medical records of individuals who were diagnosed with advanced non–small cell lung cancer and melanoma—cancers with high‐cost treatment options. Cost discussions were infrequently documented, which may hinder identifying patient cost barriers to care and tracking outcomes of associated referrals. [ABSTRACT FROM AUTHOR]

Background: Cancer survivors may face challenges affording food, housing, and other living necessities, which are known as health‐related social needs (HRSNs). However, little is known about the associations of HRSNs and mortality risk among adult cancer survivors. Methods: Adult cancer survivors were identified from the 2013–2018 National Health Interview Survey (NHIS) and linked with the NHIS Mortality File with vital status through December 31, 2019. HRSNs, measured by food insecurity, and nonmedical financial worries (e.g., housing costs), was categorized as severe, moderate, and minor/none. Medical financial hardship, including material, psychological, and behavioral domains, was categorized as 2‐3, 1, or 0 domains. Using age as the time scale, the associations of HRSNs and medical financial hardship and mortality risk were assessed with weighted adjusted Cox proportional hazards models. Results: Among cancer survivors 18–64 years old (n = 5855), 25.5% and 18.3% reported moderate and severe levels of HRSNs, respectively; among survivors 65–79 years old (n = 5918), 15.6% and 6.6% reported moderate and severe levels of HRSNs, respectively. Among cancer survivors 18–64 years old, severe HRSNs was associated with increased mortality risk (hazards ratio [HR], 2.00; 95% confidence interval [CI], 1.36–2.93, p <.001; reference = minor/none) in adjusted analyses. Among cancer survivors 65–79 years old, 2‐3 domains of medical financial hardship was associated with increased mortality risk (HR, 1.58; 95% CI, 1.13–2.20, p =.007; reference = 0 domain). Conclusions: HSRNs and financial hardship are associated with increased mortality risk among cancer survivors; comprehensive assessment of HRSN and financial hardship connecting patients with relevant services can inform efforts to mitigate adverse consequences of cancer. Health‐related social needs (HRSNs), including food insecurity and nonmedical financial worries, are associated with higher mortality risk among younger adult cancer survivors. Standardized and comprehensive assessment of HRSNs and medical financial hardship is essential to identify and mitigate adverse economic impacts of cancer. [ABSTRACT FROM AUTHOR]

Background: Siblings of children with cancer may experience adverse household economic consequences, but their financial outcomes in adulthood are unknown. Methods: A total of 880 siblings (aged 18–64 years) of adult‐aged childhood cancer survivors were surveyed to estimate the prevalence of financial hardship by three established domains (behavioral, material, and psychological). For individual financial hardship items matching the contemporaneous National Health Interview Survey or Behavioral Risk Factor Surveillance System, siblings were compared with the general population by calculating adjusted prevalence odds ratios (ORs) to sample‐weighted responses. Multivariable logistic regression models examined associations between sibling characteristics and each hardship domain and between sibling hardship and survivors' cancer/treatment characteristics. Results: Behavioral, material, and psychological hardship was reported by 24%, 35%, and 28%, respectively. Compared with national survey respondents, siblings were more likely to report worries about medical bills (OR, 1.14; 95% confidence interval [CI], 1.06–1.22), difficulty affording nutritious foods (OR, 1.79; 95% CI, 1.54–2.07), and forgoing needed medical care (OR, 1.38; 95% CI, 1.10–1.73), prescription medications (OR, 2.52; 95% CI, 1.99–3.20), and dental care (OR, 1.34; 95% CI, 1.15–1.57) because of cost. Sibling characteristics associated with reporting financial hardship in one or more domains included female sex, older age, chronic health conditions, lower income, not having health insurance, high out‐of‐pocket medical expenditures, and nonmedical/nonhome debt. No survivor cancer/treatment characteristics were associated with sibling financial hardship. Conclusions: Adult siblings of childhood cancer survivors were more likely to experience financial hardship compared with the general population. Childhood cancer may adversely affect entire households, with potentially lasting implications. Adult siblings of long‐term childhood cancer survivors may experience greater aspects of financial hardship compared with the general population. A childhood cancer diagnosis and treatment may adversely affect entire households, with potentially lasting implications. [ABSTRACT FROM AUTHOR]

Background: Cancer patients and survivors have high care needs, often provided by a spouse or partner. The purpose of this study was to elucidate how employment and work loss patterns differed across cancer history/treatment status and gender. Methods: Using nationally representative data from the Medical Expenditure Panel Survey (2011, 2016, and 2017), the authors linked data across married participants and categorized them by spouses' cancer treatment status (no cancer history, on treatment for cancer, off treatment for cancer). Multivariable logistic and zero‐inflated negative binomial regressions were used to assess the associations among cancer history/treatment status, gender, and employment outcomes (employment status and workdays lost to care for self or others). Results: For men, employment did not differ significantly by cancer history/treatment status (on treatment: odds ratio [OR], 0.58; 95% confidence interval [CI], 0.33–1.02, off treatment: OR, 0.84; 95% CI, 0.62–1.14 vs. no cancer history). For women, employment was not significantly different when the spouse was on treatment for cancer compared to no cancer history (OR, 0.78; 95% CI, 0.33–1.86]) but was significantly increased for women whose spouse was off treatment (OR, 1.39; 95% CI, 1.05–1.84). Among employed participants, women whose spouse was on cancer treatment were nine times more likely to take days off work to provide care (OR, 9.52; 95% CI, 3.94–23.03) and took more than three times as many days off to care for others (OR, 3.21; 95% CI, 2.07–4.97) as men whose spouse had no cancer history. Conclusions: Wives of cancer survivors are at increased risk of work loss, with implications for their financial and psychological well‐being. Employers, policymakers, and clinicians have opportunities to support working caregivers. Employment and productivity loss patterns differed by cancer treatment status for men and women. Wives of cancer survivors are at increased risk of work loss with implications for employers, policymakers, and health care professionals. [ABSTRACT FROM AUTHOR]

Background: Recent advancements in the clinical management of metastatic prostate cancer include several costly therapies and diagnostic tests. The objective of this study was to provide updated information on the cost to payers attributable to metastatic prostate cancer among men aged 18 to 64 years with employer‐sponsored health plans and men aged 18 years or older covered by employer‐sponsored Medicare supplement insurance. Methods: By using Merative MarketScan commercial and Medicare supplemental data for 2009–2019, the authors calculated differences in spending between men with metastatic prostate cancer and their matched, prostate cancer‐free controls, adjusting for age, enrollment length, comorbidities, and inflation to 2019 US dollars. Results: The authors compared 9011 patients who had metastatic prostate cancer and were covered by commercial insurance plans with a group of 44,934 matched controls and also compared 17,899 patients who had metastatic prostate cancer and were covered by employer‐sponsored Medicare supplement plans with a group of 87,884 matched controls. The mean age of patients with metastatic prostate cancer was 58.5 years in the commercial samples and 77.8 years in the Medicare supplement samples. Annual spending attributable to metastatic prostate cancer was $55,949 per person‐year (95% confidence interval [CI], $54,074–$57,825 per person‐year) in the commercial population and $43,682 per person‐year (95% CI, $42,022–$45,342 per person‐year) in the population covered by Medicare supplement plans, both in 2019 US dollars. Conclusions: The cost burden attributable to metastatic prostate cancer exceeds $55,000 per person‐year among men with employer‐sponsored health insurance and $43,000 among those covered by employer‐sponsored Medicare supplement plans. These estimates can improve the precision of value assessments of clinical and policy approaches to the prevention, screening, and treatment of prostate cancer in the United States. Annual spending attributable to metastatic prostate cancer was $55,949 per person‐year in the population covered by commercial insurance and $43,682 in the population covered by employer‐sponsored Medicare supplement plans, both in 2019 US dollars. These estimates can improve the precision of value assessments of clinical and policy approaches to the prevention, screening, and treatment of prostate cancer in the United States. [ABSTRACT FROM AUTHOR]

Background: Cancer survivors represent a population with high health care needs. If and how cancer survivors were affected by the first year of the coronavirus disease 2019 (COVID-19) pandemic are largely unknown.Methods: Using data from the nationwide, population-based Behavioral Risk Factor Surveillance System (2017-2020), the authors investigated changes in health-related measures during the COVID-19 pandemic among cancer survivors and compared them with changes among adults without a cancer history in the United States. Sociodemographic and health-related measures such as insurance coverage, employment status, health behaviors, and health status were self-reported. Adjusted prevalence ratios of health-related measures in 2020 versus 2017-2019 were calculated with multivariable logistic regressions and stratified by age group (18-64 vs. ≥65 years).Results: Among adults aged 18-64 years, the uninsured rate did not change significantly in 2020 despite increases in unemployment. The prevalence of unhealthy behaviors, such as insufficient sleep and smoking, decreased in 2020, and self-rated health improved, regardless of cancer history. Notably, declines in smoking were larger among cancer survivors than nonelderly adults without a cancer history. Few changes were observed for adults aged ≥65 years.Conclusions: Further research is needed to confirm the observed positive health behavior and health changes and to investigate the role of potential mechanisms, such as the national and regional policy responses to the pandemic regarding insurance coverage, unemployment benefits, and financial assistance. As polices related to the public health emergency expire, ongoing monitoring of longer term effects of the pandemic on cancer survivorship is warranted. [ABSTRACT FROM AUTHOR]

Background: Young adults and other working‐age adults with cancer are at risk for cancer‐related financial toxicity (FT), including material hardships, depletion of coping resources, and psychological burden. This study compares FT domains in young adults (18‐39 years old) (YAs), other working‐age adults (40‐64 years old), and older adults (≥65 years old) receiving cancer care. Methods: A total of 311 adults were surveyed using the multi‐domain Economic Strain and Resilience in Cancer instrument measuring FT (0‐10 score indicating least to greatest FT; score ≥5 severe FT). Participants were receiving ambulatory care from March‐September 2019. Associations of age with overall FT and material hardship, coping resource depletion, and psychological burden FT domains were tested using Kruskal‐Wallis and χ2 tests and multivariable generalized linear models with gamma distribution. Results: YAs (median age, 31.5 years) comprised 9.6% of the sample; other working‐age adults comprised 56.9%. Overall, material, coping, and psychological FT scores were worse in younger age adults versus older adults (P <.001 in all multivariable models). Compared with older adults, younger age adults demonstrated worse material hardship (median scores, 3.70 vs 4.80 vs 1.30 for YAs, other working‐age, and older adults, respectively; P <.001), coping resource depletion (4.50 vs 3.40 vs 0.80; P <.001), and psychological burden (6.50 vs 7.00 vs 1.00; P <.001). Fifty percent of YAs had severe overall FT versus 40.7% of other working‐age adults and 9.6% of older adults (P <.001). Conclusions: Younger age adults with cancer bore disproportionate FT. Interventions to address unmet needs are critical components for addressing FT in this population. Young adults (18‐39 years old) and other working‐age adults (40‐64 years old) with cancer experienced disproportionately greater financial toxicity compared with older adult (≥65 years old) counterparts. These younger adults faced not only severe material hardships but also severe depletion of their coping resources as well as psychological burden from their cancer‐related financial stressors. [ABSTRACT FROM AUTHOR]

Background: During the coronavirus disease 2019 pandemic, US unemployment rates rose to historic highs, and they remain nearly double those of prepandemic levels. Employers are the most common source of health insurance among nonelderly adults. Thus, job loss may lead to a loss of health insurance and reduce access to cancer screening. This study examined associations between unemployment, health insurance, and cancer screening to inform the pandemic's potential impacts on early cancer detection. Methods: Up‐to‐date and past‐year breast, cervical, colorectal, and prostate cancer screening prevalences were computed for nonelderly respondents (aged <65 years) with 2000‐2018 National Health Interview Survey data. Multivariable logistic regression models with marginal probabilities were used to estimate unemployed‐versus‐employed unadjusted and adjusted prevalence ratios. Results: Unemployed adults (2000‐2018) were 4 times more likely to lack insurance than employed adults (41.4% vs 10.0%; P <.001). Unemployed adults had a significantly lower up‐to‐date prevalence of screening for cervical cancer (78.5% vs 86.2%; P <.001), breast cancer (67.8% vs 77.5%; P <.001), colorectal cancer (41.9 vs 48.5%; P <.001), and prostate cancer (25.4% vs 36.4%; P <.001). These differences were eliminated after accounting for health insurance coverage. Conclusions: Unemployment was adversely associated with up‐to‐date cancer screening, and this was fully explained by a lack of health insurance. Ensuring the continuation of health insurance coverage after job loss may mitigate the pandemic's economic distress and future economic downturns' impact on cancer screening. Unemployment is adversely associated with up‐to‐date cancer screening, and this is fully explained by a lack of health insurance. [ABSTRACT FROM AUTHOR]

Background: Obesity is associated with a substantial health and economic burden in the general population in the United States. This study estimates the excess health care utilization and medical spending associated with overweight and obesity among long‐term cancer survivors. Methods: Long‐term cancer survivors (≥2 years after their diagnosis) aged ≥18 years (N = 12,547) were identified from the nationally representative 2008‐2016 Medical Expenditure Panel Survey. A 2‐part modeling approach was used to calculate the average annual care utilization and spending by service type. Excess care utilization and spending associated with overweight (25 kg/m2 ≤ body mass index [BMI] < 30 kg/m2), obesity (BMI ≥ 30 kg/m2), and severe obesity (BMI ≥ 40 kg/m2), in comparison with normal weight (18.5 kg/m2 ≤ BMI < 25 kg/m2), were estimated. Results: Compared with normal‐weight cancer survivors, overweight survivors had comparable care utilization and medical spending; survivors with obesity had an additional $3216 (95% CI, $1940‐$4492) of medical spending, including $1243 (95% CI, $417‐$2070) on hospital inpatient services and $1130 (95% CI, $756‐$1504) on prescriptions per person per year. The excess annual medical spending associated with obesity among long‐term cancer survivors translated to $19.7 billion in 2016 in the United States. The excess medical spending was magnified in cancer survivors with severe obesity ($5317 [95% CI, $2849‐$7785], which translated to $6.7 billion in 2016). Excess care utilization and medical spending were mostly explained by comorbid conditions related to obesity. Conclusions: For long‐term cancer survivors, obesity was associated with increased health care utilization and substantial excess medical spending. This suggests that policies and practices promoting a healthy lifestyle and achieving and maintaining a healthy body weight for cancer survivors may reduce their health care utilization and economic burden. Long‐term cancer survivors with obesity had $3216 of excess medical spending per person per year in comparison with normal‐weight survivors, and this translated into nearly $20 billion annually nationally in 2016 US dollars. Maintaining a healthy body weight for cancer survivors may reduce their health care utilization and economic burden. [ABSTRACT FROM AUTHOR]

The impact of disasters on the delivery of health services suggests that patients with cancer should be identified as a vulnerable population that requires additional attention and assistance during a disaster. Incorporating the special case of these patients into an event management framework can elevate resilience, decrease suffering, and save lives. [ABSTRACT FROM AUTHOR]

Background: To the authors' knowledge, little is known regarding the impact of the Patient Protection and Affordable Care Act (ACA) on people living with HIV and cancer (PLWHC), who have lower cancer treatment rates and worse cancer outcomes. To investigate this research gap, the authors examined the effects of the ACA on insurance coverage and receipt of cancer treatment among PLWHC in the United States.Methods: HIV-infected individuals aged 18 to 64 years old with cancer diagnosed between 2011 and 2015 were identified in the National Cancer Data Base. Health insurance coverage and cancer treatment receipt were compared before and after implementation of the ACA in non-Medicaid expansion and Medicaid expansion states using difference-in-differences analysis.Results: Of the 4794 PLWHC analyzed, approximately 49% resided in nonexpansion states and were more often uninsured (16.7% vs 4.2%), nonwhite (65.2% vs 60.2%), and of low income (36.3% vs 26.9%) compared with those in Medicaid expansion states. After 2014, the percentage of uninsured individuals decreased in expansion states (from 4.9% to 3%; P = .01) and nonexpansion states (from 17.6% to 14.6%; P = .06), possibly due to increased Medicaid coverage in expansion states (from 36.9% to 39.2%) and increased private insurance coverage in nonexpansion states (from 29.5% to 34.7%). There was no significant difference in cancer treatment receipt noted between Medicaid expansion and nonexpansion states. However, the percentage of PLWHC treated at academic facilities increased significantly only in expansion states (from 40.2% to 46.7% [P < .0001]; difference-in-differences analysis: 7.2 percentage points [P = .02]).Conclusions: The implementation of the ACA was associated with improved insurance coverage among PLWHC. Lack of insurance still is common in non-Medicaid expansion states. Patients with minority or low socioeconomic status more often resided in nonexpansion states, thereby highlighting the need for further insurance expansion. [ABSTRACT FROM AUTHOR]

Adults with cancer are at risk of restricted functioning in work, usual activities, life roles, and quality of life both during and after cancer treatment. Herein, the authors discuss unique opportunities to examine how cancer rehabilitation, delivered as part of cancer and survivorship care, might help to achieve the quadruple aim of better patient health, better patient experience, and lower cost for patients who receive services, as well as improving the work life of clinicians and staff. [ABSTRACT FROM AUTHOR]

Comprehensive population‐based data are critical for evaluating the effectiveness of new cancer treatment options. Current gaps in health data infrastructure present challenges for monitoring uptake, selecting comparison groups, and investigating meaningful outcomes in the general population. [ABSTRACT FROM AUTHOR]

Background: The current study examined medical financial hardship in cancer survivors and those without a cancer history in the United States.Methods: The 2013 to 2016 National Health Interview Survey was used to identify cancer survivors (stratified by ages 18-49 years [1424 survivors], ages 50-64 years [2916 survivors], and ages ≥65 years [6014 survivors]) and individuals without a cancer history (ages 18-64 years [66,951 individuals], ages 50-64 years [31,741 individuals], and ages ≥65 years [25,744 individuals]). Medical financial hardship was categorized into 3 domains: 1) material (eg, problems paying medical bills); 2) psychological (eg, worrying about paying medical bills); and 3) behavioral (eg, delaying/forgoing care due to cost). Generalized ordinal logistic regressions were used to examine the associations between cancer history, hardship, and health insurance deductibles/health savings accounts (among privately insured cancer survivors aged 18-64 years only).Results: Compared with those without a cancer history, cancer survivors were more likely to report any material (ages 18-49 years: 43.4% vs 30.1%; ages 50-64 years: 32.8% vs 27.8%; and ages ≥65 years: 17.3% vs 14.7%), psychological (ages 18-49 years: 53.5% vs 47.1%), and behavioral (ages 18-49 years: 30.6% vs 21.8%; and ages 50-64 years: 27.2% vs 23.4%) measure of financial hardship, and multiple domains of hardship (age groups 18-49 years and 50-64 years; all P < .01). Among privately insured survivors, having a high-deductible health plan without a health savings account was found to be associated with greater hardship compared with having low-deductible insurance.Conclusions: Younger cancer survivors are particularly vulnerable to material, psychological, and behavioral medical financial hardship. Interventions designed to reduce financial hardship should consider multiple domains of hardship as well as insurance benefit design. [ABSTRACT FROM AUTHOR]

Background: Cancer costs should be discussed by patients and providers, but information is not readily available. Results from recently published studies (in the last 5 years) on direct and indirect cancer costs may help guide these discussions.Methods: The authors reviewed studies published between 2013 and 2017 that reported direct health care costs and indirect (productivity losses) costs. The annual mean total and net costs of cancer were summarized for all payers and for survivors only by age (ages 18-64 and ≥65 years), by phase of care (initial [ie, 12 months from diagnosis], continuing, and end-of-life [ie, 12 months before death]), or for recently diagnosed (within 1-2 years of diagnosis) and longer term survivors.Results: For all payers combined, costs for cancers like breast, prostate, colorectal, and lung cancers were $20,000 to $100,000 in the initial phase, $1000 to $30,000 annually in the continuing phase, and ≥$60,000 in the end-of-life phase. Annual out-of-pocket costs to recently diagnosed survivors were >$1000 for medical care and time costs, approximately $2000 for productivity losses, and from $2500 to >$4000 for employment disability, depending on age. For longer term survivors, the cost of medical care was approximately $1500 for older survivors and $747 for younger survivors, time costs were $831 to $955 for older survivors and $459 to $630 for younger survivors, and productivity losses were approximately $800. Disability among long-term survivors was similar to that among short-term survivors. Limitations of the reviewed studies included older data and under-representation of higher cost cancers.Conclusions: Frequently updated cost information for all cancer types is needed to guide discussions of anticipated short-term and long-term cancer-related costs with survivors. Cancer 2018;000:000-000. © 2018 American Cancer Society. [ABSTRACT FROM AUTHOR]

Lay Summary: Cancer has substantial economic impacts for patients, their families and/or caregivers, employers, and the health care system. However, there is only limited understanding of how economic issues can affect access to cancer care services and the receipt of high‐quality cancer care.Health economics research in cancer is particularly timely due to the large and increasing number of patients with cancer and cancer survivors, but there are many factors that may create barriers to performing cancer health economics research.This commentary has identified important topics and questions in cancer health economics research and will assist in the development of this critical field. Although economic constructs influence the delivery of cancer‐related services, and cancer and its treatment have substantial economic consequences, to the authors' knowledge there is only limited understanding of how economic considerations affect health care delivery, health equity, quality of cancer care, and other cancer outcomes. This commentary presents a framework to help identify important topics and research questions in cancer health economics research and to assist in the development of this critical field. [ABSTRACT FROM AUTHOR]

Background: There is limited evidence from nationally representative samples about changes in prescription drug use for financial reasons among cancer survivors in the United States.Methods: The 2011 to 2014 National Health Interview Survey was used to identify adults who reported ever having been told they had cancer (cancer survivors; n = 8931) and individuals without a cancer history (n = 126,287). Measures of changes in prescription drug use for financial reasons included: 1) skipping medication doses, 2) taking less medicine, 3) delaying filling a prescription, 4) asking a doctor for lower cost medication, 5) buying prescription drugs from another country, and 6) using alternative therapies. Multivariable logistic regression analyses were controlled for demographic characteristics, number of comorbid conditions, interactions between cancer history and number of comorbid conditions, and health insurance coverage. Main analyses were stratified by age (nonelderly, ages 18-64 years; elderly, ages ≥65 years) and time since diagnosis (recently diagnosed, <2 years; previously diagnosed, ≥2 years).Results: Among nonelderly individuals, both recently diagnosed (31.6%) and previously diagnosed (27.9%) cancer survivors were more likely to report any change in prescription drug use for financial reasons than those without a cancer history (21.4%), with the excess percentage changes for individual measures ranging from 3.5% to 9.9% among previously diagnosed survivors and from 2.6% to 2.7% among recently diagnosed survivors (P < .01). Elderly cancer survivors and those without a cancer history had comparable rates of changes in prescription drug use for financial reasons.Conclusions: Nonelderly cancer survivors are particularly vulnerable to changes in prescription drug use for financial reasons, suggesting that targeted efforts are needed. Cancer 2017;123:1453-1463. © 2016 American Cancer Society. [ABSTRACT FROM AUTHOR]

BACKGROUND: Financial problems caused by cancer and its treatment can substantially affect survivors and their families and create barriers to seeking health care. METHODS: The authors Identified cancer survivors diagnosed as adults (n = 1556) from the nationally representative 2010 National Health Interview Survey. Using multivariable logistic regression analyses, the authors report sociodemo-graphic, clinical, and treatment-related factors associated with perceived cancer-related financial problems and the association between financial problems and forgoing or delaying health care because of cost. Adjusted percentages using the predictive margin-als method are presented. RESULTS: Cancer-related financial problems were reported by 31.8% (95% confidence interval, 29.3%-34.5%) of survivors. Factors found to be significantly associated with cancer-related financial problems in survivors included younger age at diagnosis, minority race/ethniclty, history of chemotherapy or radiation treatment, recurrence or multiple cancers, and shorter time from diagnosis. After adjustment for covariates, respondents who reported financial problems were more likely to report delay-ing (18.3% vs 7.4%) or forgoing overall medical care (13.8% vs 5.0%), prescription medications (14.2% vs 7.6%), dental care (19.8% vs 8.3%), eyeglasses (13.9% vs 5.8%), and mental health care (3.9% vs 1.6%) than their counterparts without financial problems (all PC.05). CONCLUSIONS: Cancer-related financial problems are not only disproportionately represented in survivors who are younger, members of a minority group, and have a higher treatment burden, but may also contribute to survivors forgoing or delaying medical care after cancer. [ABSTRACT FROM AUTHOR]

BACKGROUND Cancer survivors may experience long-term and late effects from treatment that adversely affect health and limit functioning. Few studies examine lost productivity and disease burden in cancer survivors compared with individuals who have other chronic conditions or by cancer type. METHODS We identified 4960 cancer survivors and 64,431 other individuals from the 2008-2010 Medical Expenditure Panel Survey and compared multiple measures of disease burden, including health status and lost productivity, between conditions and by cancer site for cancer survivors. All analyses controlled for the effects of age, sex, race/ethnicity, and number of comorbid conditions. RESULTS Overall, in adjusted analyses in multiple models, cancer survivors with another chronic disease (heart disease or diabetes) experienced higher levels of burden compared with individuals with a history of cancer only, chronic disease only, and neither cancer, heart disease, nor diabetes across multiple measures ( P < .05). Among cancer survivors, individuals with short survival cancers and multiple cancers consistently had the highest levels of burden across multiple measures ( P < .0001). CONCLUSIONS Cancer survivors who have another chronic disease experience more limitations and higher levels of burden across multiple measures. Limitations are particularly severe in cancer survivors with short survival cancer and multiple cancers. Cancer 2013;119:3393-401. © 2013 American Cancer Society. [ABSTRACT FROM AUTHOR]

The article discusses a study on the burden of illness in cancer survivors through the use of a multiple years of data from a nationally representative survey. The study used samples from the National Health Interview Survey (NHIS) during the period of 1997 to 2006. The study concluded that adult survivors of childhood cancers had poorer health outcomes as compared with individuals without cancer and suggested that physicians should be aware of the risks for adult survivors long after the diagnosis.

The article discusses a study on time costs that go with informal caregiving for cancer survivors in the U.S. The study used data from a national survey of caregivers to calculate the time spent in informal caregiving after patient diagnosis with cancer such as breast, kidney or lung. The study found that caregivers have provided care for an average of 8.3 hours daily for 13.7 months. Formal caregivers gave not only medical support but emotional support as well.

The article discusses a study which explored whether detection by mammography was associated with greater use of guideline-consistent breast cancer treatment among patients with diagnosed breast cancer in the U.S. The study found that patients who were diagnosed by mammography were more to have lower stage disease and to be treated in larger hospitals than patients who were diagnosed by other methods. It concluded that survival among patients with diagnosed breast cancer may inform understanding of factors associated with breast cancer prognosis.

ABSTRACT Background Methods Results Conclusions Health insurance coverage is critical for ensuring access to recommended health care in the United States. This study investigated the associations of health insurance coverage disruptions, also known as coverage churn, and receipt of breast and colorectal cancer screening.Adults who were age‐eligible and younger than 65 years (range, 50–64 years) for breast (n = 17,128 women) and colorectal (n = 32,562 individuals) cancer screening were identified from 5 years of the National Health Interview Survey. Adults were categorized into five groups based on insurance type at survey (private, public, none) and prior coverage disruptions within the past year. Screening outcomes included: (1) ever‐screened, (2) past‐year screening, and (3) guideline‐concordant screening. Separate multivariate logistic regression models were used to evaluate the associations between insurance coverage disruptions and cancer screening.Among adults who had coverage at the time of the survey, 3.1% with private insurance and 6.5% with public insurance reported prior coverage disruptions. Individuals without health insurance coverage had the lowest level of screening. Among individuals who had private coverage, prior disruptions were associated with lower guideline‐concordant screening in adjusted analyses (breast cancer screening: adjusted prevalence ratio [aPR], 0.82; 95% confidence interval [CI], 0.75–0.89; colorectal cancer screening: aPR, 0.78; 95% CI, 0.72–0.86); among those who had public coverage, prior disruptions were also associated with lower guideline‐concordant breast cancer screening (aPR, 0.73; 95% CI, 0.60–0.89) and colorectal cancer screening (aPR, 0.84; 95% CI, 0.72–0.99).Health insurance coverage disruptions were associated with lower past‐year and guideline‐concordant breast and colorectal cancer screening. The current findings underscore the importance of stable health insurance coverage to improve cancer screening and early detection when treatment is most effective. [ABSTRACT FROM AUTHOR]