Cancer's Lasting Financial Burden: Evidence from a Longitudinal Assessment.

BACKGROUND: To conduct a longitudinal analysis of out-of-pocket expenditure (OOPE) trajectories for the assessment of cancer's lasting financial impact.

METHODS: We identified newly diagnosed cancer patients and constructed matched non-cancer controls from the 2002-2018 Health and Retirement Study. Outcomes included monthly OOPE for prescription drugs (RX-OOPE_MONTHLY) and OOPE for medical services other than drugs in the past 2 years (non-RX-OOPE_2YR), consumer debt and new individual retirement account (IRA) withdrawals. Generalized linear models were used to compare OOPEs between cancer and matched control groups. Logistic regressions were used to compare household-level consumer debt or early IRA withdrawal. Subgroup analysis stratified patients by age, health status, and household income, with the low-income group stratified by Medicaid coverage. All statistical tests were 2-sided.

RESULTS: The study cohort included 2,022 cancer patients and 10,110 matched non-cancer controls. Mean non-RX-OOPE_2YR of cancer patients was similar to that of matched controls before diagnosis, but statistically significantly higher at diagnosis ($1,157, P < 0.001), and 2 ($511, P < 0.001), 4 ($360, P = 0.006), and 6 years ($430, P = 0.01) after diagnosis. A similar pattern was observed in RX-OOPE_MONTHLY. A statistically significantly higher proportion of cancer patients incurred consumer debt at diagnosis (34.5% vs. 29.9%, P < 0.001) and 2 years after (32.5% vs. 28.2%, P = 0.002). There was no statistically significant difference in new IRA withdrawals. Patients experienced lasting financial consequences following cancer diagnosis that were most pronounced among patients aged ≥65 years, in good-to-excellent health at baseline, and with low income, but without Medicaid coverage.

CONCLUSIONS: Policies to reduce costs and expand insurance coverage options while reducing cost-sharing are needed.