title: Healthcare Expenditure Burden Among Non-elderly Cancer Survivors, 2008-2012.
abstract: BACKGROUND
  There is increasing concern regarding the financial burden of cancer on patients and their families. This study presents nationally representative estimates of annual out-of-pocket (OOP) burden among non-elderly cancer survivors and assesses the association between high OOP burden and access to care and preventive service utilization.
  
  
  METHODS
  Using the 2008-2012 Medical Expenditure Panel Survey, 4,271 cancer survivors and 96,780 individuals without a history of cancer were identified, all aged 18-64 years. High annual OOP burden was defined as spending >20% of annual family income on OOP healthcare costs. Associations between high OOP burden and access to care were evaluated with multivariable logistic regression. Analyses were conducted in 2015.
  
  
  RESULTS
  Compared with individuals without a cancer history, cancer survivors were more likely to report a high OOP burden (4.3% vs 3.4%, p=0.009) in adjusted analyses. High OOP burden was more common among cancer survivors who were poor (18.4%), with either public insurance (7.9%) or uninsured (5.7%), and not working (10.2%). Among cancer survivors, high OOP burden was associated with being unable to obtain necessary medical care (19.2% vs 12.5%, p=0.002), delaying necessary medical care (21.6% vs 13.8%, p=0.002), and lower breast cancer screening rates among age-appropriate women (63.2% vs 75.9%, p=0.02).
  
  
  CONCLUSIONS
  High OOP burden is more common among adults with a cancer history than those without a cancer history. High OOP burden was associated with being unable to obtain necessary medical care, delaying necessary medical care, and lower breast cancer screening rates among women.
authors.affiliation: Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia. Electronic address: irm2@cdc.gov.
authors.forename: Gery P
authors.initials: GP
authors.lastname: Guy
authors.affiliation: Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland.
authors.forename: K Robin
authors.initials: KR
authors.lastname: Yabroff
authors.affiliation: Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia.
authors.forename: Donatus U
authors.initials: DU
authors.lastname: Ekwueme
authors.affiliation: Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, Georgia.
authors.forename: Katherine S
authors.initials: KS
authors.lastname: Virgo
authors.affiliation: Surveillance and Health Services Research Program, American Cancer Society, Atlanta, Georgia.
authors.forename: Xuesong
authors.initials: X
authors.lastname: Han
authors.affiliation: Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon.
authors.forename: Matthew P
authors.initials: MP
authors.lastname: Banegas
authors.affiliation: Agency for Healthcare Research and Quality, Center for Financing, Access, and Cost Trends, Rockville, Maryland.
authors.forename: Anita
authors.initials: A
authors.lastname: Soni
authors.affiliation: Surveillance and Health Services Research Program, American Cancer Society, Atlanta, Georgia.
authors.forename: Zhiyuan
authors.initials: Z
authors.lastname: Zheng
authors.affiliation: Division of Research, Kaiser Permanente Northern California, Oakland, California.
authors.forename: Neetu
authors.initials: N
authors.lastname: Chawla
authors.affiliation: Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland.
authors.forename: Ann M
authors.initials: AM
authors.lastname: Geiger
mesh_terms: D000293:Adolescent; D000328:Adult; D017281:Cost of Illness; D003695:Delivery of Health Care / Q000191:economics; D005260:Female; D019538:Health Care Surveys; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006801:Humans; D007348:Insurance, Health / Q000191:economics; D008297:Male; D017057:Medically Uninsured / Q000706:statistics & numerical data; D008875:Middle Aged; D009369:Neoplasms / Q000191:economics*; D017741:Survivors / Q000706:statistics & numerical data*; D055815:Young Adult