Financial Hardship, End-of-Life Health Care Use, and Costs in Patients With Cancer

Area of Science:

• Oncology
• Health Economics
• Health Services Research

Background:

• Patients with cancer face a higher risk of adverse financial events (AFEs) compared to the general population.
• The impact of personal finances on cancer care, especially at the end of life (EOL), remains understudied.

Purpose of the Study:

• To investigate the association between AFEs and healthcare utilization and costs at the end of life among cancer patients.

Main Methods:

• A cohort study linked cancer registry data with commercial payer, Medicare claims, and credit records.
• Included patients with solid tumors (Stage I-IV) who died between 2013-2019.
• Compared healthcare use (ED, inpatient visits, place of death) and costs in the last 3-6 months of life between patients with and without new AFEs in the preceding two years.

Main Results:

• Patients with AFEs (8.6%) had significantly higher odds of multiple ED/inpatient visits (OR 1.41) and hospital death (OR 1.50).
• Mean adjusted healthcare costs were higher for patients with AFEs in the last 3 months ($35,115 vs $31,031) and 6 months ($57,401 vs $51,602) of life.
• Incremental costs in the AFE group were $4,084 (3 months) and $5,799 (6 months).

Conclusions:

• AFEs are associated with increased healthcare utilization, higher risk of inpatient death, and elevated care costs at the end of life for cancer patients.
• Findings suggest a need to explore interventions mitigating financial hardship to improve EOL care and reduce costs for cancer patients.