Conference Coverage

MBC care causes more money problems for uninsured – but more financial stress for the insured



– Metastatic breast cancer care may be a bigger financial burden for uninsured patients, but it’s actually causing more financial distress for the insured, results of a recent survey suggest.

The uninsured more often reported material burdens, such as lack of savings or refusing treatment because of cost, according to survey results reported at a symposium on quality care sponsored by the American Society of Clinical Oncology.

By contrast, the insured reported more worry, distress, and frustration related to financial problems, reported Stephanie B. Wheeler, PhD, MPH, of the Gillings School of Global Public Health, University of North Carolina at Chapel Hill.

That divide suggests increased health insurance coverage is not enough to tackle the problem of cancer-related financial harm, said Dr. Wheeler.

“Health insurance expansion is important,” she said, “but it’s going to be ultimately inadequate in solving the problem of financial distress in our cancer patients. We really need to be thinking about other types of interventions that can do a better job of meeting patients where they are.”

Regardless of insurance status, this survey showed an “unprecedented” high level of cancer-related financial harm in metastatic breast cancer patients as compared with previous studies of early-stage cancer patients, Dr. Wheeler said.

The online survey was completed by 1,054 individuals who were members of the Metastatic Breast Cancer Network, a patient advocacy group. Approximately 30% of participants were uninsured, Dr. Wheeler reported.

Overall, 56% of respondents reported not having enough savings to cover costs of care, while 54% stopped or refused treatment because of cost, and 49% said they had been contacted by collection agencies, survey results show.

These material burdens were “perhaps not surprisingly” significantly more often reported by the uninsured respondents, Dr. Wheeler said. What may be surprising, she added, is that psychosocial burdens were more frequently reported by the insured respondents.

The most frequently reported psychosocial burden was worry about cancer-related financial problems, reported by 68% of respondents overall, but nearly 80% of insured and around 45% of uninsured respondents (P less than .001), Dr. Wheeler said.

The least often reported psychosocial issue was worry about the effects of financial stress on the family, at 31% of all respondents. Even so, there was a significant difference in response by insurance status, with the percentage approaching 40% for the insured, but less than 20% for the uninsured (P less than .001).

This high level of worry and distress may indicate that insured cancer patients may be expecting their insurance to cover more that it does, but ultimately, it is inadequate to meet their needs, Dr. Wheeler said.

“It’s also possible that because insured participants are more often affluent – they more often have retirement and other savings to draw down – that they actually have more to lose,” she added, “and when it comes to the legacy that they leave behind for their family, that creates additional stress – not just for them as an individual, but for their entire household.”

Previous research shows that the adverse financial impacts of cancer, also referred to as financial toxicity, affect about 30% of cancer patients, Dr. Wheeler said in her presentation.

Dr. Wheeler had no relationships to disclose. Funding for the project was provided from the National Comprehensive Cancer Network and Pfizer Independent Grants for Learning & Change.

SOURCE: Wheeler SB et al. Quality Care Symposium, Abstract 32.

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