Health News

Childhood cancer survivors may face decades of high medical costs

(Reuters Health) - Childhood cancer survivors may face steep out-of-pocket medical expenses well into adulthood, a recent U.S. study suggests.

Researchers examined data on 580 adults who had been diagnosed with cancer an average of three decades earlier, while they were children, and 173 of their adult siblings.

Overall, one in 10 childhood cancer survivors had high out-of-pocket health costs, spending at least 10% of their income on care, the study found. By contrast, roughly 3% of their siblings had medical costs that high.

“Many survivors of childhood cancer develop chronic health conditions, often related to the cancer or its treatment, resulting in a need for long-term medical care, which can place them at risk for experiencing financial distress related to high health care costs and time away from work,” said lead author Dr. Ryan Nipp of Massachusetts General Hospital and Harvard Medical School in Boston.

“Specifically, those with higher out-of-pocket costs were more likely to be unemployed, hospitalized in the past year, have more severe chronic medical conditions and lower incomes,” Nipp said by email.

Advances in cancer treatment in recent years have helped a growing number of young patients survive the diagnosis, often transforming their illness from a death sentence to a lifelong chronic disease.

But better survival odds also mean these children may have an elevated risk of health problems like heart disease, kidney impairment and new types of cancer in adulthood, researchers note in the Journal of Clinical Oncology, online August 17.

Over time, many healthcare plans have also increased cost-sharing with higher deductibles, co-payments or co-insurance, all of which can place a financial strain on cancer survivors.

To assess this financial impact, researchers surveyed a random sample of childhood cancer survivors and their siblings in 2011 and 2012. The survivors were part of the Childhood Cancer Survivor Study, which enrolled adults who had been treated for childhood cancers between 1970 and 1986.

Survivors who had been hospitalized in the past year were more than twice as likely to have high out-of-pocket costs, the study found.

When survivors had household income of less than $50,000 a year, they had more than five times the odds of facing high out-of-pocket costs.

Steep out-of-pocket costs also meant survivors were much more likely to struggle with paying their medical bills, defer care for a health problem, skip a test or treatment, or consider filing for bankruptcy.

One limitation of the study is that it was conducted before full implementation of the Affordable Care Act, the researchers note. As a result, the findings don’t offer any insight into how the ACA may have influenced out-of-pocket costs for cancer survivors.

“In an ever-changing landscape of insurance markets and coverage, patients and families should try to stay as informed as possible about their current health insurance coverage and use their resources in terms of social workers or hospital financial counselors to help choose plans that will provide the most adequate coverage for their needs,” advised Dr. Dava Szalda of the Children’s Hospital of Philadelphia and Penn Medicine’s Abramson Cancer Center Survivorship Program.

“Survivors of childhood cancer, at a minimum, require lifelong annual follow-up visits with attention to their cancer-related history,” Szalda, who wasn’t involved in the study, said by email. “Screening for long-term effects, while ideally preventing future morbidity and mortality, comes at a cost.”


J Clin Oncol 2017.