MMWR Morb Mortal Wkly Rep. 2019 Jun 7;68(22):494-499. doi: 10.15585/mmwr.mm6822a2.
In the United States in 2019, an estimated 16.9 million persons are living after receiving a cancer diagnosis (1). These cancer survivors face many challenges, including functional limitations, serious psychological distress (2), and other lasting and late effects of cancer treatments. Because of the high cost of cancer therapy, many cancer survivors are more likely to face substantial out-of-pocket health care expenditures and financial hardship, compared with persons without a history of cancer (3,4). Out-of-pocket expenditures and financial hardship associated with cancer have been higher among survivors aged 18-64 years than they have been among older survivors (5). To estimate annual out-of-pocket expenditures and financial hardship among cancer survivors aged 18-64 years, compared with persons without a cancer history, CDC, the American Cancer Society, and the National Cancer Institute analyzed data from the 2011-2016 Medical Expenditure Panel Survey (MEPS).* The average annual out-of-pocket spending per person was significantly higher among cancer survivors ($1,000; 95% confidence interval [CI] = $886-$1,113) than among persons without a cancer history ($622; CI = $606-$639). Financial hardship was common; 25.3% of cancer survivors reported material hardship (e.g., problems paying medical bills), and 34.3% reported psychological hardship (e.g., worry about medical bills). These findings add to accumulating evidence documenting the financial difficulties of many cancer survivors. Mitigating the negative impact of cancer in the United States will require implementation of strategies aimed at alleviating the disproportionate financial hardship experienced by many survivors. These strategies include systematic screening for financial hardship at cancer diagnosis and throughout cancer care, integration of discussions about the potential for adverse financial consequences of treatments in shared treatment decision-making, and linkage of patients and survivors to available resources to ensure access to high-quality evidence-based care.
在美国，2019 年有大约 1690 万人在被诊断患有癌症后仍然存活（1）。这些癌症幸存者面临着许多挑战，包括功能障碍、严重的心理困扰（2）以及癌症治疗的其他持久和晚期影响。由于癌症治疗的费用高昂，与没有癌症病史的人相比，许多癌症幸存者更有可能面临大量的自付医疗保健支出和经济困难（3,4）。18-64 岁的癌症幸存者的自付支出和与癌症相关的经济困难比年龄较大的幸存者更高（5）。为了估计 18-64 岁癌症幸存者与无癌症病史者相比的年度自付支出和经济困难，美国疾病控制与预防中心（CDC）、美国癌症协会（American Cancer Society）和美国国家癌症研究所（National Cancer Institute）分析了 2011-2016 年医疗支出面板调查（MEPS）的数据*。癌症幸存者的人均年自付支出（1000 美元；95%置信区间 [CI] = 886-1113）显著高于无癌症病史者（622 美元；CI = 606-639）。经济困难很常见；25.3%的癌症幸存者报告存在经济困难（例如，支付医疗费用有困难），34.3%的癌症幸存者报告存在心理困难（例如，担心医疗费用）。这些发现增加了越来越多的证据，证明许多癌症幸存者面临经济困难。减轻美国癌症的负面影响将需要实施旨在减轻许多幸存者面临的不成比例的经济困难的战略。这些策略包括在癌症诊断和整个癌症治疗过程中系统地筛查经济困难、在共同治疗决策中纳入关于治疗可能带来不利经济后果的讨论，以及将患者和幸存者与现有资源联系起来，以确保获得高质量的循证护理。
