Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia.
RTI International, Waltham, Massachusetts.
Cancer Epidemiol Biomarkers Prev. 2020 Mar;29(3):616-624. doi: 10.1158/1055-9965.EPI-19-0352.
The economic cost of breast cancer is a major personal and public health problem in the United States. This study aims to evaluate the insurance, employment, and financial experiences of young female breast cancer survivors and to assess factors associated with financial decline.
We recruited 830 women under 40 years of age diagnosed with breast cancer between January 2013 and December 2014. The study population was identified through California, Florida, Georgia, and North Carolina population-based cancer registries. The cross-sectional survey was fielded in 2017 and included questions on demographics, insurance, employment, out-of-pocket costs, and financial well-being. We present descriptive statistics and multivariate analysis to assess factors associated with financial decline.
Although 92.5% of the respondents were continuously insured over the past 12 months, 9.5% paid a "higher price than expected" for coverage. Common concerns among the 73.4% of respondents who were employed at diagnosis included increased paid (55.1%) or unpaid (47.3%) time off, suffering job performance (23.2%), and staying at (30.2%) or avoiding changing (23.5%) jobs for health insurance purposes. Overall, 47.0% experienced financial decline due to treatment-related costs. Patients with some college education, multiple comorbidities, late stage diagnoses, and self-funded insurance were most vulnerable.
The breast cancer diagnosis created financial hardship for half the respondents and led to myriad challenges in maintaining employment. Employment decisions were heavily influenced by the need to maintain health insurance coverage.
This study finds that a breast cancer diagnosis in young women can result in employment disruption and financial decline.
乳腺癌的经济成本是美国一个重大的个人和公共卫生问题。本研究旨在评估年轻女性乳腺癌幸存者的保险、就业和财务状况，并评估与财务状况恶化相关的因素。
我们招募了 830 名年龄在 40 岁以下、2013 年 1 月至 2014 年 12 月期间被诊断患有乳腺癌的女性。研究人群通过加利福尼亚、佛罗里达、佐治亚和北卡罗来纳州的人口癌症登记处确定。横断面调查于 2017 年进行，包括人口统计学、保险、就业、自付费用和财务健康状况等问题。我们展示了描述性统计数据和多变量分析，以评估与财务状况恶化相关的因素。
尽管 92.5%的受访者在过去 12 个月中连续参保，但仍有 9.5%的人支付了“高于预期”的保费。在诊断时就业的 73.4%的受访者中，常见的担忧包括增加带薪（55.1%）或无薪（47.3%）休假时间、工作表现下降（23.2%），以及出于医疗保险目的而留任（30.2%）或避免换工作（23.5%）。总的来说，47.0%的患者因治疗相关费用而出现经济困难。接受过一些大学教育、患有多种合并症、晚期诊断和自费保险的患者最为脆弱。
乳腺癌诊断给一半的受访者带来了经济困难，并导致就业面临诸多挑战。就业决策受到维持医疗保险覆盖范围的需要的严重影响。
本研究发现，年轻女性的乳腺癌诊断可能导致就业中断和经济困难。
