Most cancer survivors report financial hardship, with up to 62% reporting debt because of their cancer treatment and up to 45% not adhering to their prescription medication because of cost, according to a systematic review published in the Journal of the National Cancer Institute.1

The number of cancer survivors in the United States was estimated at 14.5 million in 2014, and is expected to increase to 18 million by 2022 as a result of an aging population and improved cancer care. But the cost of cancer care is rising, and compared with individuals without a history of cancer, survivors are known to have higher out-of-pocket (OOP) costs that last many years after initial diagnosis. Cancer survivors with financial hardship demonstrate poorer adherence and may delay or forgo cancer care.

K. Robin Yabroff, PhD, MBA, assistant secretary for planning and evaluation at the U.S. Department of Health and Human Services in Washington, DC, and one of the study’s authors, told Cancer Therapy Advisor that “measurement of financial hardship has been inconsistent and many studies have not been clear about the aspect of hardship being measured.”

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The goal of the systematic review was “to synthesize findings for material, psychological, and behavioral components of financial hardship across studies and provide a typology or framework for future research and for development of interventions to minimize the effects of financial hardship,” said Dr Yabroff.

The systematic review included studies from the United States published between January 1, 1990 and December 31, 2015.

Material conditions such as OOP, medical debt, and missed work, as well as psychological response and coping behaviors, were the domains considered to constitute financial hardship in the analysis.

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The average OOP medical costs per month for cancer survivors ranged from $316 to $741. Several included studies reported that OOP expenses were greater than 20% of the patient’s annual income. Indirect costs—defined as loss of income, missed or lost days of work, time costs, and limited abilities to do work or outside work activities—ranged from a mean annual loss of $380 (prostate cancer) to $8236 (breast cancer).