Impact of Financial Barriers to Care on Adverse Healthcare Events among Cancer Patients and Survivors

Objectives: This study (i) examines the association between financial barriers to care and adverse healthcare events among cancer survivors using quantitative and qualitative methods, and (ii) evaluates the impact of reducing non-medical financial barriers to care during active cancer treatment on missed appointments. These aims work together to investigate one potential mechanism underlying the association between financial hardship and negative clinical outcomes.Methods: We first examined the association of patient-reported financial barriers to care with emergency department (ED) visits and inpatient hospitalization among adult Medicare beneficiaries with a history of cancer using 2011 – 2017 Medicare Current Beneficiary Survey data. We then employed qualitative analysis, conducting semi-structured interviews with adult cancer survivors experiencing financial toxicity to understand how financial barriers to care influence adverse healthcare events and health outcomes. Lastly, we retrospectively evaluated a financial assistance intervention focused on supporting patients’ non-medical needs (e.g., transportation, lodging) during active cancer treatment between 2015 and 2019. By applying propensity weighting with a natural comparison group, we evaluated the effect of this program in terms of its influence on rates of missed infusion chemotherapy/immunotherapy and radiation therapy appointments.Results: We found that 11% of Medicare beneficiaries with a history of cancer reported experiencing financial barriers in the prior year. We did not identify associations between patient-reported financial barriers and healthcare utilization in the overall sample; however, Black or African American beneficiaries reporting financial barriers were less likely to be hospitalized in the following year. Qualitative interviews with 20 adults with a history of cancer shed light on the emotional and physical health consequences of attempting to overcome financial barriers experienced, influenced by multi-level protective and hindering factors. We also found that a non-medical financial assistance program reduced radiation therapy missed appointment rates by over 50% and was cost saving to the health system. Discussion: These findings demonstrate the consequences of financial barriers on healthcare utilization and physical and emotional well-being among adults with a history of cancer. They also point to one potential approach to reduce cost-related missed appointments by providing direct non-medical financial assistance to patients receiving radiation therapy.