JNCCN: Younger cancer survivors far more likely to experience food and financial insecurity

PLYMOUTH MEETING, PA [March 12, 2020] — New research from the American Cancer Society in the March 2020 issue of JNCCN–Journal of the National Comprehensive Cancer Network finds that younger cancer survivors are more likely to experience significant financial strain for daily living necessities, such as food, housing, and monthly bills, even years after diagnosis. Among survivors between ages 18 and 39, 20.4% expressed high levels of worry about paying monthly bills compared to 12.9% of individuals without a history of cancer. Likewise, 6.3% of cancer survivors in that age group reported being unable to afford balanced meals, versus 3.4% of those without a cancer history. The findings were less consistent for survivors in the 40-64 age group, and the disparities disappeared for those 65-and-older.

“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,” explained lead researcher Zhiyuan Zheng, PhD, American Cancer Society, who also worked with researchers from UCLA and The Center for Health Research at Kaiser Permanente on this study. “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.”

“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,” Dr. Zheng continued.

For this study, the researchers used the 2013-2017 National Health Interview Survey (NHIS), a cross-sectional household survey from the National Center for Health Statistics within the Centers for Disease Control and Prevention. Their sample included 12,141 cancer survivors–defined as those who reported every being diagnosed with cancer or any malignancy by a doctor or other health professional, excluding nonmelanoma skin cancer–(771 age 18-39; 4,269 age 40-64; and 7,101 age 65 and older) and 143,664 individuals without a cancer history (53,262 age 18-29; 60,141 age 40-64; and 30,261 age 65 and older). They sorted financial concerns into categories related to retirement, standard of living, monthly bills, and housing costs. They also assigned a point system to the responses “very worried,” “moderately worried,” “not too worried,” and “not worried at all,” in order to quantify the impact these types of concerns were having on the different age groups and cancer-survival groups. They similarly scored food insecurity based on “worry about food running out,” “food not lasting,” and “unable to afford balanced meals.”

The adjusted analyses found that 26.4% of cancer survivors age 18-39 reported severe financial worry, and 12.6% reported severe food insecurity. For the 40-64 year-old cohort, 22.2% reported severe financial worry, and 6.8% severe food insecurity. Among those 65-and-older, 6.9% reported severe financial worry, and 2.3% had severe food insecurity.

“Young adult survivors are more vulnerable to financial instability for many reasons related to the tasks of young adult development, such as early career disruptions, the need for increased child care, costs of fertility treatment, or unexpected costs of medical care,” commented Karen M. Fasciano, PsyD, Dana-Farber Cancer Institute, an expert on cancer survivorship and young adults who was not involved in this research. “In addition, the psychological impact of being a cancer survivor as a young adult is greater than for older adults and includes being exposed to uncertainty at an age earlier than most peers. When a negative event has happened one time, it follows that a young person is primed to worry about future uncertainty in life domains including financial and food security.”

The researchers call for additional study evaluating the relative impact of different financial hardships on long-term outcomes for cancer survivors. They also highlighted some policies they consider promising steps toward 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 Dr. Zheng. “In addition, the Centers 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.”

To read the entire study, visit JNCCN.org. Complimentary access to “Worry About Daily Financial Needs and Food Insecurity Among Cancer Survivors in the United States” is available until June 10, 2020.

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More than 25,000 oncologists and other cancer care professionals across the United States read JNCCN–Journal of the National Comprehensive Cancer Network. This peer-reviewed, indexed medical journal provides the latest information about innovation in translational medicine, and scientific studies related to oncology health services research, including quality care and value, bioethics, comparative and cost effectiveness, public policy, and interventional research on supportive care and survivorship. JNCCN features updates on the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®), review articles elaborating on guidelines recommendations, health services research, and case reports highlighting molecular insights in patient care. JNCCN is published by Harborside. Visit JNCCN.org. To inquire if you are eligible for a FREE subscription to JNCCN, visit http://www.nccn.org/jnccn/subscribe.aspx. Follow JNCCN on Twitter @JNCCN.

The National Comprehensive Cancer Network® (NCCN®) is a not-for-profit alliance of 28 leading cancer centers devoted to patient care, research, and education. NCCN is dedicated to improving and facilitating quality, effective, efficient, and accessible cancer care so patients can live better lives. Through the leadership and expertise of clinical professionals at NCCN Member Institutions, NCCN develops resources that present valuable information to the numerous stakeholders in the health care delivery system. By defining and advancing high-quality cancer care, NCCN promotes the importance of continuous quality improvement and recognizes the significance of creating clinical practice guidelines appropriate for use by patients, clinicians, and other health care decision-makers around the world.

The NCCN Member Institutions are: Abramson Cancer Center at the University of Pennsylvania, Philadelphia, PA; Fred & Pamela Buffett Cancer Center, Omaha, NE; Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; City of Hope National Medical Center, Duarte, CA; Dana-Farber/Brigham and Women’s Cancer Center | Massachusetts General Hospital Cancer Center, Boston, MA; Duke Cancer Institute, Durham, NC; Fox Chase Cancer Center, Philadelphia, PA; Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT; Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance, Seattle, WA; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; Mayo Clinic Cancer Center, Phoenix/Scottsdale, AZ, Jacksonville, FL, and Rochester, MN; Memorial Sloan Kettering Cancer Center, New York, NY; Moffitt Cancer Center, Tampa, FL; The Ohio State University Comprehensive Cancer Center – James Cancer Hospital and Solove Research Institute, Columbus, OH; O’Neal Comprehensive Cancer Center at UAB, Birmingham, AL; Roswell Park Comprehensive Cancer Center, Buffalo, NY; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, MO; St. Jude Children’s Research Hospital/The University of Tennessee Health Science Center, Memphis, TN; Stanford Cancer Institute, Stanford, CA; UC San Diego Moores Cancer Center, La Jolla, CA; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; University of Colorado Cancer Center, Aurora, CO; University of Michigan Rogel Cancer Center, Ann Arbor, MI; The University of Texas MD Anderson Cancer Center, Houston, TX; University of Wisconsin Carbone Cancer Center, Madison, WI; Vanderbilt-Ingram Cancer Center, Nashville, TN; and Yale Cancer Center/Smilow Cancer Hospital, New Haven, CT.

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