Elsevier Global Medical News. 2010 Mar 1, C Helwick
NEW ORLEANS (EGMN) - A survey of cancer patients confirms that financial hardship is part of the disease package. Investigators found that 28% of patients, mostly those with advanced disease, were in danger of losing their homes, and financial hardships were strongly associated with mental health issues.
Responses from 428 consecutive cancer outpatients revealed that 64% had limited or very limited financial resources as a result of their disease. Only 38% reported no financial hardship, Sharla Wells-Di Gregorio, Ph.D., reported at the annual conference of the American Psychosocial Oncology Society.
"We were completely unprepared to see patients losing their homes, and others presenting with stage IV disease as a result of financial issues. ... Many patients reported that they avoided going to the doctor for months, or years in some cases, because they didn't have insurance and could not afford it," said Dr. Wells-Di Gregorio, a clinical psychologist with the center for palliative care at the Ohio State University in Columbus.
Exacerbating cost-of-care issues, only 8% of the patients were employed full time; 65% were not working because of medical disability, and 7% worked part time. Prior to developing cancer, 89% had a stable employment history, and 93% said they were satisfied with their jobs.
The investigators had hypothesized that patients who experienced moderate to severe financial difficulties would exhibit higher rates of major depressive disorder and generalized anxiety disorder than would patients who reported no financial difficulties, along with more depressive symptoms, pain, pain catastrophizing (out-of-proportion perception of pain), and symptom distress.
Half of the patients surveyed were female, 83% were white, 53% were married, and the average patient had at least a high school education. More than half had metastases, and two-thirds were undergoing chemotherapy or radiotherapy at the time of the survey at one Ohio cancer center.
Measures included the Center for Epidemiologic Studies Depression Scale (CES-D), the Brief Pain Inventory (BPI), the Pain Catastrophizing scale (PCS), and the Memorial Symptom Assessment Scale (MSAS). Patients also completed an interview to determine whether they had major depression or generalized anxiety.
"These financial difficulties also put the patients at greater risk for depression, anxiety, pain, and symptom distress," Dr. Wells-Di Gregorio reported, based on their scores on the validated instruments.
Criteria for depression were met by 43% of patients who reported financial issues, compared with 23% of patients without money problems (P = .02); criteria for anxiety were met by 36% and 15%, respectively (P = .001).
Those with financial difficulties had significantly higher pain severity scores on the BPI (P = .001), significantly more physical symptoms on the MSAS (P = .039), and significantly more psychological symptoms on the MSAS (P = .001). Pain catastrophizing scores were not significantly different.
Dr. Wells-Di Gregorio noted that previous studies have shown that 20% of cancer patients with health insurance use all or most of their savings to pay for care, and 10% borrow money from relatives. Out-of-pocket expenses for insured women with breast cancer account for 26%-98% of their monthly income, depending on whether their income was more than $60,000 or less than $30,000, she said. Among those without insurance, 50% use up all their savings to help pay medical expenses, 40% are unable to pay for basic necessities, 25% decline or delay treatment, and 6% file for bankruptcy.
Furthermore, 6% of patients lose coverage as a result of having cancer, and 10% are unable to purchase it after a diagnosis. "While these numbers don't sound high, based on national figures we are talking about 88,000 [6% of 1.5 million new cases] and 720,000 patients [6% of 12 million survivors] ... a year," Dr. Wells-Di Gregorio said.
"And in addition to physical and financial disability, patients suffer emotional disability," she added. "They become fearful of losing their jobs. Due to common beliefs about disability and welfare, they begin to feel financially incompetent and stigmatized."
Noting that patients also worry about the impact on their families, Dr. Wells-Di Gregorio concluded her talk with the suggestion that advance care planning for cancer patients include some way "to assure that families can survive in the case of patient death."
For patients with financial issues as well as their health care providers, a little-known organization is waiting to help. It is the Cancer Legal Resource Center, a nationwide joint program of the Disability Rights Legal Center and Loyola Law School in Los Angeles.
"Legal issues can cause people unnecessary worry, confusion, and stress, and can be overwhelming. When [these issues] are not addressed, people may find that although they have survived the disease, they have lost their homes, jobs, insurance, or families," the organization's director, Joanna Morales, said at the conference in a presentation on how to help patients navigate the financial maze of cancer.
The Cancer Legal Resource Center (
www.cancerlegalresourcecenter.org) provides free, confidential information and resources on cancer-related legal issues to cancer survivors, families, friends, employers, health care professionals, and others coping with cancer. Such issues may include insurance coverage, employment discrimination, access to health care, and estate planning.
Among the materials available from the CLRC is an 11-page booklet, "How to Ensure Your Treatment Gets Paid For," which includes sections on applying for free or charity care, strategies for negotiating hospital bills, tips for disputing bills and insurance company decisions, and a description of laws that prohibit harassing debt-collection practices.
The CLRC has a national, toll-free, telephone assistance line (866-THE-CLRC), where callers can receive free, confidential information about relevant laws and resources for their particular situations. Members of the CLRC' staff of attorneys, insurance representatives, and accountants have provided in-depth information and counsel to more than 30,000 callers, according to the Web site. They also hold conferences, seminars, workshops, and outreach programs on legal topics for cancer patents.
Dr. Wells-Di Gregorio disclosed no financial conflicts of interest.
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