Younger Cancer Survivors See Higher Burden of Financial Worry and Food Insecurity

Younger cancer survivors, especially those aged 18-64 years, are faced with a higher burden of financial worry and food insecurity compared with those who don’t have a history of cancer, according to a study published in the Journal of the National Comprehensive Cancer Network.¹

Moreover, lower socioeconomic status and higher comorbidities were found to be associated with higher intensities of financial worry and food insecurity among cancer survivors. 

“This could be because younger cancer survivors are not able to maintain their jobs due to health conditions, and therefore lose their health insurance coverage,” lead researcher Zhiyuan Zheng, PhD, of the American Cancer Society, said in a press release.² “At the same time, they may have substantial other financial obligations, such as student loans, mortgage obligations, and child-rearing responsibilities. Younger cancer survivors may have had fewer opportunities to accumulate wealth, and for millennials specifically, I think they are living in an economic environment with low interest rates and low saving rates, combined with the rapidly increasing costs of cancer care, they face significant challenges in paying large out-of-pocket costs.” 

Using the National Health Interview Survey, researchers identified cancer survivors and individuals without a cancer history aged 18–39 years (n = 771 vs 53,262, respectively), 40–64 years (n = 4,269 vs 60,141), and ≥65 years (n = 7,101 vs 30,261).

Within both groups, adjusted proportions were generated for financial worry about retirement, standard of living, monthly bills, and housing costs on a scale of “very worried,” “moderately worried,” or “not worried.” Food insecurity was evaluated using a scale of “often,” “sometimes,” and “not true.” Additionally, food insecurity adjusted analyses assessed intensity measures of financial worry and food insecurity on a scale of “severe,” “moderate,” “minor,” or “none” among cancer survivors only. 

Compared with those without a cancer history, cancer survivors aged 18-39 years reported consistently higher “very worried” levels in regard to retirement (25.5% vs 16.9%; P < 0.001), standard of living (20.4% vs 12.9%; P < 0.001), monthly bills (14.9% vs 10.3%; P = 0.002), and housing costs (13.6% vs 8.9%; P = 0.001), as well as higher “often true” levels regarding worry about food running out (7.9% vs 4.6%; P=.004), food not lasting (7.6% vs 3.3%; P=.003), and being unable to afford balanced meals (6.3% vs 3.4%; P=.007). These findings were not as consistent in cancer survivors aged 40-64 years.

Contrastingly, the results were generally similar for adults aged ≥65 years with or without a history of cancer. Among cancer survivors, 57.6% of those aged 18–39 years (P < 0.001), 51.9% of those aged 40–64 years (P < 0.001), and 23.8%  of those aged ≥65 years reported severe or moderate financial worry intensity, and 27.0% (P < 0.001), 14.8% (P < 0.001), and 6.3%, respectively, experienced severe or moderate food insecurity intensity. Furthermore, in all 3 age groups, lower income and higher comorbidities were generally correlated with greater intensities of financial worry and food insecurity.

Given these findings, the authors called for additional studies evaluating the relative impact of different financial hardships on long-term outcomes for cancer survivors. They also addressed the need for interventions and policy efforts that aid in reducing food insecurity and financial worry among this unique population. 

“For survivorship planning, we should address the needs of patients with younger age, lower family income, and a higher number of comorbid conditions, and develop both clinical and health policy interventions to reduce the impact of cancer on nonmedical financial burden and food insecurity in the United States,” Zheng said. 

Zheng also drew attention to some policies that he considers as promising for potentially addressing these concerns.

“Congress passed the Deferment for Active Cancer Treatment Act of 2018, which allows patients with cancer to postpone payments on public student loans while they are actively receiving cancer treatment,” said Zheng. “In addition, the Center for Medicare & Medicaid Services has also expanded Medicare Advantage coverage to allow insurers to include healthy groceries, rides to medical appointments, and home delivered meals in their new benefits for qualified younger people with disabilities. These efforts, plus some state-level Medicaid policies, may provide much-needed help for cancer survivors.”

References:

1. Zheng Z, Jemal A, Tucker-Seeley R, et al. Worry About Daily Financial Needs and Food Insecurity Among Cancer Survivors in the United States. Journal of the National Comprehensive Cancer Network. doi:10.6004/jnccn.2019.7359.

2. JNCCN: Younger Cancer Survivors Far More Likely to Experience Food and Financial Insecurity than their Cancer-Free Peers, According to Researches from American Cancer Society [news release]. Plymouth Meeting, Pennsylvania. Published March 12, 2020. prnewswire.com/news-releases/jnccn-younger-cancer-survivors-far-more-likely-to-experience-food-and-financial-insecurity-than-their-cancer-free-peers-according-to-researchers-from-american-cancer-society-301021825.html. Accessed March 12, 2020.