Introduction:

Financial toxicity (FT) describes the overall mental and economic burden that results from cancer diagnosis and treatment. Due to rising costs of direct and out of pocket patient responsibility, novel diagnostics, and therapeutics in kidney cancer (KC), many of the survivors are dealing with FT implications as part of their cancer journey. Existing data have identified FT to impede delivery of the highest quality of care and long-lasting psychological impact. We aimed to analyze the subjective financial distress experienced by survivors with KC utilizing large national Center for Disease Control (CDC) health surveys over the last decade.

Methods:

We used 2008-2016 CDC National Health Interview Surveys (NHIS) to identify adults with history of kidney cancer.  We measured the following financial stressors 1) delaying or foregoing medical care 2) delay in dental care 3) worry about medical bills 4) delay in seeking mental health 5) difficulties paying for prescription medication. We used both sampling and design variables to account for the complex survey design of the NHIS and participant nonresponse, as well as to make the estimates nationally representative. Multivariable logistic regression modeling using the predictive margins methods was used to estimate the association between covariates and the KC related problems.

Results:

We identified adults aged 18-64 years (n=217,043) and ≥65 years (n=54,235) from the 2008-2018 NHIS. Compared to those without cancer, KC survivors (18-64 years) were more likely to report a) inability to afford prescription medication (29.6% vs 17.5%, p<0.001) and b) inability to afford mental health care (4.7 % vs 2.71%, p<0.001). After adjusting for covariates, younger patients with history of KC were more likely to experience problems affording prescription medication (OR 2.03(1.49-2.78), p<0.001) as compared to healthy adults. Similarly, older KC survivors were more likely to report financial distress secondary to prescription medication (OR 1.47(1.05-1.99), p=0.02), however, they were less likely to report worrying about paying for medical costs (OR 0.66 (0.52-0.89), p<0.01).

Conclusion:

Our study underscores the importance of individual assessment of FT by age. Younger KC survivors are particularly vulnerable to toxicities associated with cancer treatment, including rising cost of prescription medication and inability to afford mental healthcare.

Funding: N/A