Some Young Cancer Survivors Paying Hefty Costs 20 Years Later

Adolescent and young adult (AYA) cancer survivors experiencing psychological distress may use substantially more medical care and face significantly higher out-of-pocket medical expenses, a recent study suggests.

Specifically, researchers found that AYA cancer survivors with psychological distress paid about $4400 more per year in medical expenses than their peers without such distress and approximately $1800 more than adults reporting psychological distress but no history of cancer. Much of those extra costs can be attributed to the additional medical office visits (almost three more per year) and drug prescriptions or renewals (11.6 more per year) these AYA cancer survivors receive, the authors report.

"Together, these findings highlight the magnitude of the economic burden and health care utilization associated with psychological distress in AYA cancer survivors," Ola A. Abdelhadi, MBBCh, MPH, PhD, of the University of California, Davis, and colleagues write in their analysis, published online January 10 in Cancer.

Another notable finding: The psychological distress among AYA cancer survivors often lasts decades. Overall, 11.5% of almost 1800 AYA cancer survivors in the study reported experiencing psychological distress, and for most, this feeling persisted for 20 years or more after their diagnosis.

"We used to pay attention to the psychological health among recent cancer survivors," Abdelhadi told Medscape Medical News. "However, based on our results, it looks like psychological distress is a problem among long-term survivors as well."

Elizabeth Siembida, PhD, who was not involved in the analysis, agreed. "We often lapse into the belief that the longer someone is cancer free, the [more that] fears, anxieties, and worries related to cancer and its treatment dissipate," said Siembida, assistant professor at the Feinstein Institutes for Medical Research in Manhasset, New York. "Among young adult survivors of cancer, this assumption isn't always true, and the results of this study really emphasize this point."

Previous studies have found that many AYA cancer survivors experience significant psychological distress that may lead to depression, anxiety, post traumatic stress disorder, and high-risk behaviors such as smoking.

However, according to Abdelhadi and colleagues, no studies have explored the extra medical expenses and healthcare use associated with this distress.

In the analysis, the researchers used data from the 2011–2016 Medical Expenditure Panel Survey to identify 1757 AYA cancer survivors between ages 15 and 39 and a matched sample of 5227 adults with no history of cancer.

The researcher found that the prevalence of psychological distress was twice as high in AYA cancer survivors compared to matched adults with no history of cancer (11.5% vs 5.8%) — a finding that aligns with earlier population-based studies of cancer survivors. And, the authors found, this distress can persist over many years. For 11.2% of AYA cancer survivors, these feelings of distress persisted at least 2 decades after their diagnosis.

In terms of medical expenses, AYA cancer survivors with psychological distress paid, on average, $4415 more each year compared to their peers without psychological distress. In matched adults without a history of cancer, psychological distress was associated with an additional $1802 in annual medical expenditures.

Those with psychological distress also averaged 2.8 more office visits and received almost 11.6 more prescription medications or renewals each year than AYA cancer survivors not experiencing distress. These cancer survivors were also more likely to have chronic conditions such as depression as well as smoke, exercise less regularly, and have public insurance or be uninsured.

The findings highlight the critical importance of identifying psychological distress in AYA cancer survivors early and intervening as soon as possible to reduce both the symptoms and costs associated with this distress, Siembida said. The scientific literature and the clinical guidelines set by national organizations such as the American Society of Clinical Oncology have reached a consensus on the importance of distress screening in cancer patients and survivors, she noted.

"We can't ignore the significant mental health impact of a cancer diagnosis, especially among young survivors, and its continued impact long into survivorship," Siembida told Medscape Medical News. "Regularly checking in with cancer survivors regarding their mental health and connecting them with supportive care services when necessary is a critical component of cancer care both during and after treatment."

The study results also point to the important role that health behaviors such as smoking and low physical activity play in the quality of life of cancer survivors and underscore the need for interventions that focus on these behaviors, Siembida added.

Notably, the study found no significant differences in psychological distress by cancer type. "Cancer research tends to be siloed by cancer type," Siembida said. "I think it's important to recognize that some issues are pervasive across these siloes and important to consider no matter what type of cancer a person is diagnosed with."

The authors and Siembida have disclosed no relevant financial relationships.

Cancer. Published online January 10, 2022. Full text

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