Even among the insured, cost may delay follow up care for cancer survivors

STATUE: (from left) Drs. Jie Chen, Steven S. Coughlin and Jorge E. Cortes see more

Credit: Augusta University

Even among a large group of cancer survivors who were largely insured, graduated from college, and had an annual income above the national average, care delayed up to 10% in the past 12 months because they simply didn’t have out-of-pocket expenses such as copays and were able to pay deductibles, researchers report.

Not being able to take time off from work and being “ nervous’ ‘about seeing a health care provider were among the other often-cited reasons for not always getting on-time survivors’ care, report researchers from the Medical College of Georgia and Georgia Cancer Center in the journal Cancer Medicine.

Researchers analyzed data from 5,426 cancer survivors who volunteered to share their information with the National Institutes of Health’s All of Us Research Program, a historic effort to collect and study health data over many years from at least one million people living in the United States live. Cancer survivors were an average of 67 years old, mostly female and white with a history of a variety of cancers.

“It is likely that these rates are much higher among cancer survivors in the general population, and particularly among minorities and other populations with significant health disparities in general,” Dr. Steven S. Coughlin, interim chief of the Division of Epidemiology in the MCG Department of Population Health Sciences, and colleagues report.

Survivors’ care may need to be continued throughout a patient’s life, and the population at particular risk of not being able to afford care includes racial minorities as well as women, younger individuals and those with lower incomes who are the most affected. have trouble making ends meet.

“There are subgroups of the population primarily at higher risk of poor access, financial hardship and cancer,” says Coughlin. “Those are the individuals we are especially concerned about.”

“You can imagine that if you go to these populations that are still highly underrepresented in many such surveys, such as African Americans, Hispanics, and individuals living in more rural communities, these problems are likely to increase tenfold, if not more,” Says Dr. Jorge E. Cortes, director of the Georgia Cancer Center and a co-author of the study.

“Some people have lifelong obligations because of the investment they had to make to pay for their treatment, so now they are healed, but they are in debt, they may have lost their jobs, there may have been tensions in their personal and family relationships. Assessment and management of all these aspects of the patient as a whole are incorporated into this science of survival, which is an integral part of cancer care today, ”says Cortes.

There were an estimated 16.9 million cancer survivors in the US in January 2019, a number expected to increase to 22.2 million by 2030, according to the National Cancer Institute.

With improved cancer treatment and resulting improved survival rates, oncologists have been thinking about and talking to their patients about survival at the time of diagnosis, rather than acting reactively, Cortes says, with the goal of additional problems for the survivors. to prevent or at least minimize ‘financial and emotional health.

“You can’t prevent the emotional impact that a cancer diagnosis can have on someone,” Cortes says. “We are all human and it has a big impact, but maybe you can help the patient navigate the impact it can have.”

An important aspect of these types of published analyzes is to raise awareness of the impact of all these factors, Cortes says. “It’s an important part in cancer management. What this analysis, as well as other reviews that Drs. Coughlin and (Jie) Chen and others have done, is to bring that to the fore.”

One goal of the All of Us program is to ultimately build a database that reflects the diversity of the country so that good data becomes available to groups, such as blacks, women and ultimately children, who have been historically underrepresented in medical research.

The uniqueness of this growing national database is that we are able to collect information from people who participate voluntarily, and use data analytics to extract information from the advanced database to answer relevant research questions, said study co-author Chen, head. of the MCG Division of Biostatistics. and Data Science. More volunteers are needed, along with good data science, allowing researchers to extract the insights the data provides, fully answering questions like Coughlin’s and Cortes’s, and better helping patients and families navigate the aftermath of a cancer diagnosis , she says.

Coughlin and his colleagues Cortes and Chen plan to revisit the survival data as the 6-year-old database grows and diversifies.

In the current analysis, MCG researchers looked at demographic factors and other personal characteristics such as insured and employment status, personal medical history of cancer, health care use, and access to the national database. The most common cancers were breast, prostate and colorectal cancers, which are among the top five cancers in the US. Patients with skin cancer, the most common form of cancer, were excluded from their study because their need for follow-up care is often relatively low.

About half of the individuals surveyed had an annual income of $ 75,000 or more, while the median household income was $ 68,703 in 2019, according to the US Census Bureau. About 47% had private health insurance, 41% had Medicare, 6% had Medicaid, and the rest were insured through the military or the Department of Veterans Affairs, other insurers, or were uninsured.

According to the Centers for Disease Control and Prevention, 12.1% of people in the US under 65 are uninsured and about 64% have private insurance. Medicare is available to people 65 and older, according to the United States Department of Health and Human Services.

In any case, in the current dataset, minorities were not significantly more likely to be deferred care in the past 12 months, and only a small percentage were uninsured. The researchers again note that there was likely an underrepresentation of individuals most at risk for these problems in the database that patients choose to participate in.

Previous studies have shown that uninsured cancer survivors are more likely to avoid care, including prescription medications, actions associated with worse outcomes, the researchers write. Studies have also found that survivors of black, Hispanic, and other minority cancer patients were more likely than whites to have not had a cancer-related medical visit in the past year, and another found that Hispanic survivors had the lowest insured rates and not even routine medical examinations. care in the previous year. Younger cancer survivors are also more likely to forgo healthcare because of the cost.

Based on these kinds of previous findings, the MCG researchers also expected that survivors who are black or Hispanic would be the least likely to receive health care and experience greater barriers to care than whites, they write.

“Health inequalities are widespread, people across the country are struggling to make ends meet and pay for their survival care,” said Coughlin, who worked for more than a decade in the cancer prevention and control division at the Centers for Disease Control and Prevention. has long been an interest in better tackling cancer survival.

Survivors often have lifelong health care needs, including preventive care, watching for recurrence of the cancer being treated or a new malignancy, and cancer treatment-related morbidity, including problems such as infection and bleeding, and the impact of the treatment on other body organs, such as the heart. as well as managing chronic health conditions that make them more vulnerable. For example, 10-20% of breast cancer survivors have diabetes, sometimes because of overlapping risk factors such as inactivity and obesity, and some prostate cancer therapies can accelerate diabetes in men, Coughlin says.

Improving the survival rates of a variety of cancers has prompted oncologists to think more about things like the cost of the drugs they prescribe, and more likely to refer patients to a psychologist or psychiatrist, especially those who already have have problems such as depression or stress, even before they are diagnosed with cancer. There is also an increasing use of social workers and financial advisers to work with families early on, Cortes says.

This more aggressive emphasis on survival reflects the positive reality that more patients are surviving, the researchers say.

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