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Functional impairment is associated with medical debt in male cancer survivors and credit card debt in female cancer survivors

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Abstract

Purpose

To examine the associations of functional limitations with medical and credit card debt among cancer survivor families and explore sex differences in these associations.

Methods

This cross-sectional study used data from the 2019 wave of the Panel Study of Income Dynamics, a nationally representative, population-based survey of individuals and households in the US administered in both English and Spanish and includes all households where either the head of household or spouse/partner reported having been diagnosed with cancer. Participants reported on functional limitations in six instrumental activities of daily living (IADL) and seven activities of daily living (ADL). Functional impairment was categorized as 0, 1–2 and ≥ 3 limitations. Medical debt was defined as self-reported unpaid medical bills. Credit card debt was defined as revolving credit card debt. Multivariable logistic regression analyses were performed.

Results

Credit card debt was more common than medical debt (39.8% vs. 7.6% of cancer survivor families). Families of male cancer survivors were 7.3 percentage points more likely to have medical debt and 16.0 percentage points less likely to have credit card debt compared to families of female cancer survivors. Whereas male cancer survivors with increasing levels of impairment were 24.7 percentage point (p-value = 0.006) more likely to have medical debt, female survivors with more functional impairment were 13.6 percentage points (p-value = 0.010) more likely to have credit card debt.

Conclusions

More research on medical and credit card debt burden among cancer survivors with functional limitations is needed.

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Data availability

The data analyzed during the current study is public use and is available from the Institute for Social Research at the University of Michigan at https://psidonline.isr.umich.edu/.

Code availability

Code is available from the corresponding author on reasonable request.

References

  1. Levey NN (2022) In America, Cancer Patients Endure Debt on Top of Disease. Kaiser Health News. https://khn.org/news/article/in-america-cancer-patients-endure-debt-on-top-of-disease/. Accessed 25 July 2022

  2. Nekhlyudov L, Walker R, Ziebell R, Rabin B, Nutt S, Chubak J (2016) Cancer survivors’ experiences with insurance, finances, and employment: results from a multisite study. J Cancer Surviv 10(6):1104–1111. https://doi.org/10.1007/s11764-016-0554-3

    Article  PubMed  Google Scholar 

  3. Yabroff KR, Dowling EC, Guy GP, Banegas MP, Davidoff A, Han X, Virgo KS, McNeel TS, Chawla N, Blanch-Hartigan D, Kent EE, Li C, Rodriguez JL, de Moor JS, Zheng Z, Jemal A, Ekwueme DU (2015) Financial hardship associated with cancer in the United States: findings from a population-based sample of adult cancer survivors. J Clin Oncol 34(3):259–267. https://doi.org/10.1200/JCO.2015.62.0468

    Article  PubMed  PubMed Central  Google Scholar 

  4. Han X, Zhao J, Zheng Z, de Moor JS, Virgo KS, Yabroff KR (2020) Medical financial hardship intensity and financial sacrifice associated with cancer in the United States. Cancer Epidemiol Biomark Prev 29(2):308. https://doi.org/10.1158/1055-9965.EPI-19-0460

    Article  Google Scholar 

  5. Veenstra CM, Regenbogen SE, Hawley ST, Griggs JJ, Banerjee M, Kato I, Ward KC, Morris AM (2014) A composite measure of personal financial burden among patients with stage III colorectal cancer. Med Care 52(11):957–962. https://doi.org/10.1097/mlr.0000000000000241

    Article  PubMed  PubMed Central  Google Scholar 

  6. Chavan PP, Kedia SK, Mzayek F, Ahn S, Yu X (2021) Impact of self-assessed health status and physical and functional limitations on healthcare utilization and mortality among older cancer survivors in US. Aging Clin Exp Res 33(6):1539–1547. https://doi.org/10.1007/s40520-020-01654-5

    Article  PubMed  Google Scholar 

  7. Grafova IB (2015) Financial status and chronic conditions onset among non-elderly adults. Rev Econ Househ 13(1):53–72. https://doi.org/10.1007/s11150-012-9172-7

    Article  Google Scholar 

  8. Wiltshire JC, Dark T, Brown RL, Person SD (2011) Gender differences in financial hardships of medical debt. J Health Care Poor Underserved 22(1):371–388. https://doi.org/10.1353/hpu.2011.0000

    Article  PubMed  Google Scholar 

  9. Dunn LF, Mirzaie IA (2016) Consumer debt stress, changes in household debt, and the great recession. Econ Inq 54(1):201–214. https://doi.org/10.1111/ecin.12218

    Article  Google Scholar 

  10. Banegas MP, Schneider JL, Firemark AJ, Dickerson JF, Kent EE, de Moor JS, Virgo KS, Guy GP, Ekwueme DU, Zheng Z, Varga AM, Waiwaiole LA, Nutt SM, Narayan A, Yabroff KR (2019) The social and economic toll of cancer survivorship: a complex web of financial sacrifice. J Cancer Surviv 13(3):406–417. https://doi.org/10.1007/s11764-019-00761-1

    Article  PubMed  PubMed Central  Google Scholar 

  11. Grafova IB, Manne SL, Bandera EV, Saraiya B, Llanos AAM, Devine KA, Hudson SV, Paddock LE, Tsui J, Elliott J, Stroup AM, Duberstein PR (2021) Financial hardship among cancer survivors in Southern New Jersey. Support Care Cancer. https://doi.org/10.1007/s00520-021-06232-7

    Article  PubMed  Google Scholar 

  12. Lentz R, Benson AB III, Kircher S (2019) Financial toxicity in cancer care: prevalence, causes, consequences, and reduction strategies. J Surg Oncol 120(1):85–92. https://doi.org/10.1002/jso.25374

    Article  PubMed  Google Scholar 

  13. Pearce A, Tomalin B, Kaambwa B, Horevoorts N, Duijts S, Mols F, van de Poll-Franse L, Koczwara B (2019) Financial toxicity is more than costs of care: the relationship between employment and financial toxicity in long-term cancer survivors. J Cancer Surviv 13(1):10–20. https://doi.org/10.1007/s11764-018-0723-7

    Article  PubMed  Google Scholar 

  14. Kalousova L, Burgard SA (2014) Tough choices in tough times: debt and medication nonadherence. Health Educ Behav 41(2):155–163. https://doi.org/10.1177/1090198113493093

    Article  PubMed  Google Scholar 

  15. Internal_Revenue_Service (2020) Requirements for 501(c)(3) Hospitals Under the Affordable Care Act – Section 501(r). Internal Revenue Service. https://www.irs.gov/charities-non-profits/charitable-organizations/requirements-for-501c3-hospitals-under-the-affordable-care-act-section-501r. Accessed 22 June 2021

  16. Smith AM, Gilbert P (2016) Fair credit reporting act and financial privacy update—2015. Bus Lawyer 71(2):661–670

    Google Scholar 

  17. Veena S, Li L, Catherine F, Hayley S, Yuxian D, Sara K, Karma K, Scott R (2022) Risk of adverse financial events in patients with cancer: evidence from a novel linkage between cancer registry and credit records. J Clin Oncol 40(8):884–891. https://doi.org/10.1200/jco.21.01636

    Article  Google Scholar 

  18. Liu C, Gotanda H, Khullar D, Rice T, Tsugawa Y (2021) The affordable care act’s insurance marketplace subsidies were associated with reduced financial burden for US adults. Health Aff (Millwood) 40(3):496–504. https://doi.org/10.1377/hlthaff.2020.01106

    Article  PubMed  Google Scholar 

  19. Dodini S Insurance subsidies, the affordable care act, and financial stability. J Policy Anal Manag n/a:(n/a). https://doi.org/10.1002/pam.22418

  20. Beaule A, Campbell F, Dascola M, Insolera N, Johnson D, Juska P, McGonagle K, Simmert B, Warra J (2021) PSID main interview user manual: release 2021. University of Michigan, Ann Arbor

    Google Scholar 

  21. Census_Bureau (2020) How the Census Bureau measures poverty. Guidance for Poverty Data Users. https://www.census.gov/topics/income-poverty/poverty/guidance/poverty-measures.html. Accessed 25 Nov 2021

  22. Katz S, Ford AB, Moskowitz RW, Jackson BA, Jaffe MW (1963) Studies of illness in the aged: the index of ADL: a standardized measure of biological and psychosocial function. JAMA 185(12):914–919. https://doi.org/10.1001/jama.1963.03060120024016

    Article  CAS  PubMed  Google Scholar 

  23. Lawton MP, Brody EM (1969) Assessment of older people: self-maintaining and instrumental activities of daily living1. Gerontologist 9(3_Part_1):179–186. https://doi.org/10.1093/geront/9.3_Part_1.179

    Article  CAS  PubMed  Google Scholar 

  24. Spector WD, Fleishman JA (1998) Combining activities of daily living with instrumental activities of daily living to measure functional disability. J Gerontol B Psychol Sci Soc Sci 53(1):S46-57. https://doi.org/10.1093/geronb/53b.1.s46

    Article  CAS  PubMed  Google Scholar 

  25. Johnston KJ, Wen H, Hockenberry JM, Joynt Maddox KE (2018) Association between patient cognitive and functional status and medicare total annual cost of care: implications for value-based payment. JAMA Intern Med 178(11):1489–1497. https://doi.org/10.1001/jamainternmed.2018.4143

    Article  PubMed  PubMed Central  Google Scholar 

  26. Extermann M, Overcash J, Lyman GH, Parr J, Balducci L (1998) Comorbidity and functional status are independent in older cancer patients. J Clin Oncol 16(4):1582–1587. https://doi.org/10.1200/jco.1998.16.4.1582

    Article  CAS  PubMed  Google Scholar 

  27. Kim YJ, Kim JH, Park M-S, Lee K-W, Kim K-I, Bang S-M, Lee JS, Kim C-H (2011) Comprehensive geriatric assessment in Korean elderly cancer patients receiving chemotherapy. J Cancer Res Clin Oncol 137(5):839–847. https://doi.org/10.1007/s00432-010-0945-1

    Article  CAS  PubMed  Google Scholar 

  28. Dow WH, Norton EC, Donahoe JT (2019) Stata tip 134: multiplicative and marginal interaction effects in nonlinear models. Stand Genomic Sci 19(4):1015–1020. https://doi.org/10.1177/1536867x19893644

    Article  Google Scholar 

  29. Mize TD (2019) Best practices for estimating, interpreting, and presenting nonlinear interaction effects. Sociol Sci 6:81–117. https://doi.org/10.15195/v6.a4

    Article  Google Scholar 

  30. U.S._Bureau_of_Labor_Statistics (2021) American Time Use Survey Summary

  31. Ortiz-Ortiz KJ, Tortolero-Luna G, Torres-Cintrón CR, Zavala-Zegarra DE, Gierbolini-Bermúdez A, Ramos-Fernández MR (2021) High-intensity end-of-life care among patients with GI cancer in Puerto Rico: a population-based study. JCO Oncol Pract 17(2):e168–e177. https://doi.org/10.1200/op.20.00541

    Article  PubMed  PubMed Central  Google Scholar 

  32. Tang ST, Wu SC, Hung YN, Chen JS, Huang EW, Liu TW (2009) Determinants of aggressive end-of-life care for Taiwanese cancer decedents, 2001 to 2006. J Clin Oncol 27(27):4613–4618. https://doi.org/10.1200/jco.2008.20.5096

    Article  PubMed  Google Scholar 

  33. Merrill SS, Seeman TE, Kasl SV, Berkman LF (1997) Gender differences in the comparison of self-reported disability and performance measures. J Gerontol A Biol Sci Med Sci 52(1):M19-26. https://doi.org/10.1093/gerona/52a.1.m19

    Article  CAS  PubMed  Google Scholar 

  34. de Moor JS, Mollica M, Sampson A, Adjei B, Weaver SJ, Geiger AM, Kramer BS, Grenen E, Miscally M, Ciolino HP (2021) Delivery of financial navigation services within National Cancer Institute–Designated Cancer Centers. JNCI Cancer Spectrum 5(3). https://doi.org/10.1093/jncics/pkab033

  35. van Smeden M, Lash TL, Groenwold RHH (2019) Reflection on modern methods: five myths about measurement error in epidemiological research. Int J Epidemiol 49(1):338–347. https://doi.org/10.1093/ije/dyz251

    Article  PubMed Central  Google Scholar 

  36. Parker K, Minkin R, Bennett J (2020) Economic fallout from COVID-19 continues to hit lower-income Americans the hardest. Pew Research Center

  37. Croda E, Grossbard S (2021) Women pay the price of COVID-19 more than men. Rev Econ Househ 19(1):1–9. https://doi.org/10.1007/s11150-021-09549-8

    Article  PubMed  PubMed Central  Google Scholar 

  38. Liu B, Halpern MT (2022) The NCI patterns of care studies small numbers reporting guidelines. Patterns of care studies series. National cancer institute, Bethesda, MD

  39. Huang S-T, Ke X, Huang Y-P, Wu Y-X, Yu X-Y, Liu H-K, Liu D (2023) A prediction model for moderate to severe cancer-related fatigue in colorectal cancer after chemotherapy: a prospective case-control study. Support Care Cancer 31(7):426. https://doi.org/10.1007/s00520-023-07892-3

    Article  PubMed  Google Scholar 

  40. Grafova IB, Clifford PR, Hudson SV, Steinberg MB, O’Malley DM, Elliott J, Llanos AAM, Saraiya B, Duberstein PR (2022) Disease and debt: findings from the 2019 panel study of income dynamics in the United States. Prev Med 164:107248. https://doi.org/10.1016/j.ypmed.2022.107248

    Article  PubMed  PubMed Central  Google Scholar 

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author information

Authors and Affiliations

  1. Edward J. Bloustein School of Planning and Public Policy, Rutgers University, 33 Livingston Avenue, New Brunswick, NJ, 08901, USA

    Irina B. Grafova & Jennifer Elliott

  2. Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA

    Irina B. Grafova, Sharon L. Manne, Shawna V. Hudson, Biren Saraiya & Paul R. Duberstein

  3. Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School, Piscataway, NJ, USA

    Shawna V. Hudson

  4. Department of Health Behavior, Society, and Policy, Rutgers School of Public Health, Piscataway, NJ, USA

    Paul R. Duberstein

  5. Department of Epidemiology, Mailman School of Public Health and Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, NY, USA

    Adana A. M. Llanos

  6. Department of Medicine, Rutgers Robert Wood Johnson Medical School, Piscataway, NJ, USA

    Biren Saraiya

Authors
  1. Irina B. Grafova
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  2. Sharon L. Manne
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  3. Shawna V. Hudson
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  4. Jennifer Elliott
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  5. Adana A. M. Llanos
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  6. Biren Saraiya
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  7. Paul R. Duberstein
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Contributions

Study conception and design: Grafova, Duberstein; Acquisition of data: Grafova; Analysis and interpretation of data: Grafova, Duberstein, Saraiya; Drafting of manuscript: Grafova, Duberstein, Saraiya; Critical revision: Grafova, Manne, Hudson, Elliott, Llanos, Saraiya, Duberstein.

Corresponding author

Correspondence to Irina B. Grafova.

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Ethical approval

All recruitment and study methods were approved by the appropriate Institutional Review Board (Approval Number: Pro2021001888).

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Competing interests

Biren Saraiya served on an advisory board for Eisai and Sanofi; Dr. Saraiya reports personal fees from Sanofi, personal fees from Eisai, outside the submitted work;.

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Grafova, I.B., Manne, S.L., Hudson, S.V. et al. Functional impairment is associated with medical debt in male cancer survivors and credit card debt in female cancer survivors. Support Care Cancer 31, 605 (2023). https://doi.org/10.1007/s00520-023-08070-1

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