Nipp Ryan D, Kirchhoff Anne C, Fair Douglas, Rabin Julia, Hyland Kelly A, Kuhlthau Karen, Perez Giselle K, Robison Leslie L, Armstrong Gregory T, Nathan Paul C, Oeffinger Kevin C, Leisenring Wendy M, Park Elyse R
Ryan D. Nipp, Julia Rabin, Kelly A. Hyland, Karen Kuhlthau, Giselle K. Perez, and Elyse R. Park, Massachusetts General Hospital; Ryan D. Nipp, Karen Kuhlthau, Giselle K. Perez, and Elyse R. Park, Harvard Medical School, Boston, MA; Anne C. Kirchhoff, Douglas Fair, Huntsman Cancer Institute, Salt Lake City, UT; Leslie L. Robison and Gregory T. Armstrong, St Jude Children's Research Hospital, Memphis, TN; Paul C. Nathan, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Kevin C. Oeffinger, Memorial Sloan Kettering Cancer Center, New York, NY; and Wendy M. Leisenring, Fred Hutchinson Cancer Research Center, Seattle, WA.
J Clin Oncol. 2017 Oct 20;35(30):3474-3481. doi: 10.1200/JCO.2016.71.7066. Epub 2017 Aug 17.
Purpose Survivors of childhood cancer may experience financial burden as a result of health care costs, particularly because these patients often require long-term medical care. We sought to evaluate the prevalence of financial burden and identify associations between a higher percentage of income spent on out-of-pocket medical costs (≥ 10% of annual income) and issues related to financial burden (jeopardizing care or changing lifestyle) among survivors of childhood cancer and a sibling comparison group. Methods Between May 2011 and April 2012, we surveyed an age-stratified, random sample of survivors of childhood cancer and a sibling comparison group who were enrolled in the Childhood Cancer Survivor Study. Participants reported their household income, out-of-pocket medical costs, and issues related to financial burden (questions were adapted from national surveys on financial burden). Logistic regression identified associations between participant characteristics, a higher percentage of income spent on out-of-pocket medical costs, and financial burden, adjusting for potential confounders. Results Among 580 survivors of childhood cancer and 173 siblings, survivors of childhood cancer were more likely to have out-of-pocket medical costs ≥ 10% of annual income (10.0% v 2.9%; P < .001). Characteristics of the survivors of childhood cancer that were associated with a higher percentage of income spent on out-of-pocket costs included hospitalization in the past year (odds ratio [OR], 2.3; 95% CI, 1.1 to 4.9) and household income < $50,000 (OR, 5.5; 95% CI, 2.4 to 12.8). Among survivors of childhood cancer, a higher percentage of income spent on out-of-pocket medical costs was significantly associated with problems paying medical bills (OR, 8.9; 95% CI, 4.4 to 18.0); deferring care for a medical problem (OR, 3.0; 95% CI, 1.6 to 5.9); skipping a test, treatment, or follow-up (OR, 2.1; 95% CI, 1.1 to 4.0); and thoughts of filing for bankruptcy (OR, 6.6; 95% CI, 3.0 to 14.3). Conclusion Survivors of childhood cancer are more likely to report spending a higher percentage of their income on out-of-pocket medical costs, which may influence their health-seeking behavior and potentially affect health outcomes. Our findings highlight the need to address financial burden in this population with long-term health care needs.
目的 儿童癌症幸存者可能因医疗费用而承受经济负担，尤其是因为这些患者通常需要长期医疗护理。我们试图评估经济负担的患病率，并确定儿童癌症幸存者及其兄弟姐妹对照组中，自付医疗费用占收入的比例较高（≥年收入的10%）与经济负担相关问题（危及医疗护理或改变生活方式）之间的关联。方法 在2011年5月至2012年4月期间，我们对参加儿童癌症幸存者研究的按年龄分层的儿童癌症幸存者随机样本及其兄弟姐妹对照组进行了调查。参与者报告了他们的家庭收入、自付医疗费用以及与经济负担相关的问题（问题改编自关于经济负担的全国性调查）。逻辑回归分析确定了参与者特征、自付医疗费用占收入的较高比例与经济负担之间的关联，并对潜在混杂因素进行了调整。结果 在(580)名儿童癌症幸存者和(173)名兄弟姐妹中，儿童癌症幸存者更有可能自付医疗费用≥年收入的(10%)（(10.0%)对(2.9%)；(P <.001)）。与自付费用占收入比例较高相关的儿童癌症幸存者特征包括过去一年住院（比值比[OR]，(2.3)；(95%)置信区间[CI]，(1.1)至(4.9)）和家庭收入<(50,000)美元（OR，(5.5)；(95%)CI，(2.4)至(12.8)）。在儿童癌症幸存者中，自付医疗费用占收入的比例较高与支付医疗账单困难（OR，(8.9)；(95%)CI，(4.4)至(18.0)）、因医疗问题推迟护理（OR，(3.0)；(95%)CI，(1.6)至(5.9)）、错过检查、治疗或随访（OR，(2.1)；(95%)CI，(1.1)至(4.0)）以及申请破产的想法（OR，(6.6)；(95%)CI，(3.0)至(14.3)）显著相关。结论 儿童癌症幸存者更有可能报告其收入中用于自付医疗费用的比例较高，这可能会影响他们的就医行为，并可能影响健康结果。我们的研究结果强调了在这一有长期医疗护理需求的人群中解决经济负担问题的必要性。
