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Cancer Survivors Say Costs Keep Them From Care
Date:2/4/2009

Insured or not, patients forgo medical needs twice as often as others, study finds ,,

WEDNESDAY, Feb. 4 (HealthDay News) -- Unmanageable health-care costs are forcing millions of insured and uninsured cancer survivors in the United States to go without the medical attention they need, a new analysis reveals.

What's more, the study indicates that Hispanic and African-American cancer survivors are twice as likely as white survivors to forgo crucial care because of financial impediments.

"We're estimating that approximately 2 million cancer survivors do not get the medical care that they need because of concerns about cost," said Kathryn E. Weaver, a cancer prevention fellow in the Office of Cancer Survivorship at the National Cancer Institute and the study's lead author.

"And the majority of these patients do have some kind of insurance coverage," she noted. "So this is typically about the burden of deductibles for health insurance plans, co-pays that can be thousands and thousands of dollars a year, the loss in productivity that comes with taking time off from work and transportation costs to get back and forth to care."

In fact, Weaver said, cancer survivors younger than 65 were almost twice as likely to go without needed health care as were people that age who'd never had cancer.

The cancer institute researchers were expected to present their findings this week at the American Association for Cancer Research conference on the Science of Health Care Disparities in Carefree, Ariz.

The cited figure of 2 million makes up almost 17 percent of the estimated 12 million Americans currently living -- often for many years -- with a cancer diagnosis.

The estimate is based on a review of data collected between 2003 and 2006 by the U.S. Center for Disease Control and Prevention's annual "National Health Interview Survey" of 30,000 to 40,000 American households.

From the survey, Weaver and her associates focused on the health-care-seeking behavior of 6,602 adult cancer survivors and more than 104,000 men and women with no history of cancer.

Almost 65 percent of the survivors were women, almost 5 percent were Hispanic and just over 6 percent were black. Roughly half (52 percent) were older than 65 and had access to Medicare insurance. Only people with non-melanoma skin cancer were excluded.

The pool of cancer survivors included people with relatively recent diagnoses as well as those diagnosed a decade or more ago. In fact, nearly 60 percent of the participants were more than five years out from their initial diagnosis.

Because of this, the analysis not only reflected behavior related to seeking care for cancer concerns, but also attempts to get medical attention for such issues as obtaining prescription medications and accessing dental and mental health care.

Weaver and her team found that almost 8 percent of the cancer survivors chose to go without general medical care because of its cost. For the same reason, nearly 10 percent did without needed prescriptions, more than 11 percent went without dental care, and nearly 3 percent failed to address mental health needs.

The situation appeared more dire for non-white cancer survivors. Hispanic cancer survivors, for instance, were twice as likely as their white peers to forgo prescription drugs because of cost. African-Americans were 87 percent more likely than whites to do that.

Costs drove dental care to the wayside 2.3 times more often among Hispanic cancer patients than among white patients and 57 percent more often among African-American patients.

Such racial disparities were not exclusive to cancer patients, the researchers noted, although health-care patterns were not always the same for the general population as among cancer patients.

In addition, race did not appear to play a role among cancer patients older than 65 -- perhaps because access to Medicare leveled the playing field.

"Certainly, having access to health insurance is better than not, because, unsurprisingly, you're much more likely to forego care if you have no access," Weaver said. "But clinicians need to be aware that a relatively substantial proportion of survivors -- including those with insurance -- are not getting the care they need because of cost and try to identify sources of care that are available for their patients at a lower fee."

Dr. Steffie Woolhandler, an associate professor of medicine at Harvard Medical School in Boston and co-author of a medical bankruptcy paper from the Consumer Bankruptcy Project, described the findings as unsurprising but "nonetheless appalling."

"In my own hospital, I was recently involved with a gentleman who refused chemotherapy for Hodgkin's -- a potentially curable disease -- because he couldn't afford the co-pay," she noted. "So, we have many people who have private insurance but find that there are so many gaps in their coverage that, even so, they can't afford the care they need."

"Of course, unfortunately, most of the mainstream health-care reform proposals in Washington right now talk only about covering the uninsured," Woolhandler added. "And that's important. We certainly support that. But what's not being discussed is that already insured people can't afford the health care they need. So we need changes in policy that ensure that insured people get the health care they need."

More information

The National Coalition on Health Care has more on the economics of health care.



SOURCES: Kathryn E. Weaver, Ph.D., cancer prevention fellow, Office of Cancer Survivorship, U.S. National Cancer Institute, Bethesda, Md.; Steffie Woolhandler, M.D., associate professor, medicine, Harvard Medical School, Boston; abstract, conference on Science of Health Care Disparities, Feb. 3-6, 2009, American Association for Cancer Research, Carefree, Ariz.


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