Large medical debts, bankruptcy related to thyroid cancer

Patients with thyroid cancer may experience greater financial hardship than people with other common cancers, according to a recent study.

Researchers found, for example, that patients with thyroid cancer had higher total annual healthcare expenditures, on average, than patients with other types of cancer ($9,585 vs. $5,830 ), and that bankruptcy rates were higher.

the review was published online May 5 in JAMA Otorhinolaryngology–Head and Neck Surgery.

Research on the costs associated with cancer care indicates that thyroid cancer, in particular, comes with a significant financial burden for patients and survivors.

In this review, Benjamin James, MD, Beth Israel Deaconess Medical Center, Boston, and colleagues assessed all known studies on the financial burden of thyroid cancer to capture the evidence to date and identify knowledge gaps. .

Among the included studies, James and his co-authors found that estimates of out-of-pocket costs for thyroid cancer diagnosis and treatment varied widely, ranging from $1,425 to $17,000 in the first year after diagnosis. The medical debt associated with thyroid cancer care ranged from about 2% to nearly 19%.

These costs were influenced by a range of factors, including cancer stage, health insurance coverage and age. For example, patients who have undergone thyroidectomy with malignant disease experienced higher median costs ($29,171 vs. $17,335) and out-of-pocket costs ($3,019 vs. $2,271) compared to their peers with mild disease. Disbursements varied by type of health insurance. The highest costs were incurred by patients with high-deductible health plans ($4,265) and the lowest for those with health maintenance plans ($1,529).

Bankruptcy rates among thyroid cancer patients were also notable. In one study, 41% of patients declared bankruptcy 5 years after being diagnosed. Another analysis found that the incidence of bankruptcy 1 year after a cancer diagnosis was highest for thyroid cancer (9.3 per 1,000 person-years) compared to other cancers – in particular, lung, leukemia/lymphomacolorectal, melanoma, breast, prostate and uterus – although thyroid cancer “generally requires relatively less extensive treatment”, note the authors. In this study, younger patients were more likely to declare bankruptcy.

Among cancer survivors, an analysis found that three times as many thyroid cancer survivors reported being in debt or borrowing money (19% vs. 6%) compared to breast cancer patients, prostate, colon or lung. Thyroid cancer survivors were twice as likely to be uninsured (5.4%) as patients with breast, prostate, colon or lung cancer (2.4% ). Lack of insurance coverage increases the risk of material financial hardship sevenfold.

The financial burden associated with thyroid cancer can also affect patients’ mental health and employment. Thyroid Cancer Survivors’ Association Cohort Results study showed that financial difficulties related to thyroid cancer were associated with greater anxiety, depressionand social functioning.

This study also found that 18% of patients reported being unemployed for at least 6 months and 42.5% reported having less work-related income due to thyroid cancer care. To manage these personal expenses, almost a quarter said they used most or all of their savings, and about 16% were contacted by a collection agency.

Despite the growing body of evidence on the financial burden associated with thyroid cancer, there is little data on how these financial obligations accrue and how employment and insurance coverage may change over time. time.

While highly reliable, these estimates “represent an incomplete approximation of the true financial burden borne by patients,” the authors note. “Further research is needed to examine how debt accumulation over time affects employment, insurance coverage, health outcomes and bankruptcy.”

The study was supported by the National Institutes of Health. James did not disclose any relevant financial relationship.

JAMA Otolaryngol Head Neck Surg. Published online May 5, 2022. Abstract

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John A. Bogar