Financial burden among older, long-term cancer survivors: Results from the LILAC study

Abstract

Background: Increasing attention is being paid to financial burdens of cancer survivorship, but little is known about the prevalence and predictors of these burdens in older, long-term survivors.

Methods: We used data from 6012 participants diagnosed with cancer since enrolling in the Women's Health Initiative, and who participated in the Life and Longevity After Cancer (LILAC) ancillary study to estimate prevalence and identify predictors of financial burden. We used logistic regression to identify sociodemographic, socioeconomic, health- and cancer-related factors associated with financial burden and backward selection to build a final multivariable model.

Results: Average age at LILAC participation was 79 and 9.2 years had elapsed since cancer diagnosis. Overall, 6% experienced some form of financial burden, including having an insurance company refuse a claim (2.6%), being denied loans or insurance due to cancer history (2.2%), or experiencing significant indebtedness (1.8%, including facing large debts or bills or declaring bankruptcy). Eight predictors remained associated (P < 0.05) with financial burden in the fully-adjusted model: younger age, shorter time since diagnosis, African-American race, household income <$20 000/year, modified Charlson comorbidity score ≥2, receipt of chemotherapy, regional stage at diagnosis, and no private health insurance. Education, cancer site, social support, receipt of radiation, and receipt of hormone therapy were not associated with financial burden. Predictors differed between types of financial burden experienced and age at diagnosis (<65 vs 65+).

Conclusion: Cancer-related financial burden was rare in this population of older, female long-term cancer survivors. The identification of several socioeconomic, health-related and demographic predictors of financial burden may suggest targets of intervention to reduce financial burdens.

Precis: Financial burden was uncommon in older, female, long-term survivors. Predictors of financial burden included age, race, income, comorbidities, time since diagnosis, stage, insurance, and receipt of chemotherapy.

Keywords: cancer; cancer economics; cancer therapy; financial hardship; survivorship.