Cost burdens prevent young cancer survivors from seeking routine medical care


Few are more fatigued than those just finished fighting. Beyond the hard knocks and the roped ring awaits a period of reanimation and repose, where the victor contemplates their next move. For young cancer survivors fresh off the literal fight for their lives, that next move is often not made toward routine medical examinations — a strategy that may cost them dearly in the long run, according to a recent study published in a journal of the American Cancer Society.

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Anne Kirchhoff, PhD, MPH, of the Huntsman Cancer Institute at the University of Utah in Salt Lake City, co-author of the study, and her team analyzed national survey responses from young adults aged 20 to 39 — 979 of whom had been diagnosed with cancer between ages 15 to 34 and had at least five years separating them from their diagnosis — and ultimately found that young cancer survivors were less likely to seek medical care later in life due to cost burdens. Researchers found that survivors were 67 percent more likely to opt out of routine medical care because of costs faced in the year prior; those between 20-29 years old (44 percent compared to 16 percent of controls), female patients (35 percent vs. 16 percent of controls), and those in particularly poor health were the most apprehensive when considering the cost of care.

Given that former cancer patients are more susceptible to other conditions as a result of radiation exposure, etc., checking in during periods of health could mean early diagnosis and thus, swifter treatment of issues that could possibly arise later down the road.

“The important thing for physicians to remember is that this population of young adult cancer survivors is growing pretty rapidly and that they are at a pretty significant risk for health complications from their treatment,” Jennifer Wright, MD, co-author of the study, told PhysBizTech. “Because of that, it’s important to remember as you’re seeing patients who are survivors, that they may not be getting adequate care in terms of follow-up. As a physician, your approach should be fairly thorough with them; they’re going to be at risk for things that are uncommon in their age group in terms of long-term complications and things of the like. Follow-up care is sub-optimal so when you’re seeing these patients be aware of that concept.”

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Wright was quick to point out that shifting these avenues of thought will be no easy task. “It’s hard that the burden is to them upfront but it becomes a burden on the system later if they don’t get those preventative services,” she said. “I don’t know if there is much one physician can do, but in general I think that as a system we have to spend more time educating the survivors as to why it is important to spend that money upfront and make sure you’re getting the care you need. I’m hopeful — although who knows what the Affordable Care Act [ACA] will really translate to on the patient level — that [ACA] will improve access for these patients, they won’t be disqualified because of a preexisting condition, and this age group will have better coverage under their parents longer. Hopefully that will help decrease the problems on the system level, but of course we’ll see how that actually pans out.”

Amongst the study’s most surprising results was the comparable rate in coverage existent within both the cancer survivor demographic (21 percent uninsured) and the control group (23 percent uninsured).

“I actually thought we would find that this group of survivors would be less insured than their age-comparable population,” Wright said. “What we found is that they carry insurance at about the same rate.”

Nevertheless, Wright spoke of engaging all survivors through forms of technology and comprehensive health summaries as paramount to getting such patients back into the doctor’s office.

“There is a standard recommendation now that all cancer survivors at the end of their treatment are given a summary of their treatment so that they can have access to that information regarding what kind of drugs they were exposed to, details about their radiation, and so on. That kind of information can be very helpful also to primary care physicians and physicians in general. But I think while that’s a recommendation, a lot of oncologist aren’t very good about providing that information.”

Delivering these risk assessments to patients could ultimately remove the pronounced barrier of cost from the survivor’s path and place it in healthcare’s rear-view.

“If as a whole, we can get better about that and disseminate a survivor’s treatment information to whomever they’re seeing, that might help in terms of getting some of their costs taken care of in one visit instead of having them go to multiple specialties,” Wright said. “I think also that when survivors have that information, it empowers them to remember that there are things that need to be continually watched for as they go on with their lives. It would be nice if we as a community of oncologists could be better about getting that information into the hands of the survivors and other doctors.”

When prompted about the use of electronic medical records and health information exchanges as aides to this aim, Wright was enthusiastic about the sovereignty of said health tech-tools.

“We actually have a computerized program that we use to assemble treatment summaries and these software platforms are becoming more common so that it is easier on the physician side,” she said. “There [are] a couple of programs out there that if you put in whatever the kilo or radiation exposure was, it’s spits out the recommendation for what the patients needs to be monitored or screened for. Because technology is so universal in other parts of our lives, patients are becoming more and more expectant of something like that, where they can either get a print-out or…log-on and see parts of their own health records.”

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