Even among a large group of cancer survivors who were mostly insured, college educated and had annual incomes above the national average, up to 10% delayed care in the previous 12 months because they simply could not afford out of pocket expenses like copays and deductibles, investigators report.
Being unable to get time off from work and being "nervous" about seeing a health care provider, were among the other frequently cited reasons for not always getting timely survivorship care, investigators at the Medical College of Georgia and Georgia Cancer Center report in the journal Cancer Medicine.
Investigators 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. The cancer survivors were a mean age of 67, mostly female and white with a history of a variety of cancers.
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"It is likely that these percentages are much higher among cancer survivors in the general population, and particularly among minorities and other populations suffering 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 his colleagues report.
Survivorship care may need to continue throughout a patient's lifetime, and populations at particular risk for being unable to afford the care include racial minorities as well as women, younger individuals and those with lower incomes struggling most to make ends meet.
"There are subgroups of the population who are at higher risk for poor access, for financial hardship and for cancer in the first place," Coughlin says. "Those are the individuals we are particularly worried about."
"You can imagine that if you go to these populations that are still grossly under-represented in many of these types of surveys, such as African Americans, Hispanics, and individuals who live in more rural communities, these problems are probably magnified tenfold if not more," says Dr. Jorge E. Cortes, director of the Georgia Cancer Center and a study coauthor.
"Some people have lifelong commitments because of the investment they had to make to pay for their treatment, so now they are cured but they are in debt, they may have lost their job, there may be strains that developed in their personal and family relationships. Assessment and management of all these aspects of the patient as a whole have been incorporated into this science of survivorship, which is an integral part of cancer care nowadays," Cortes says.