Administrative Burden as a Potential Cause of Financial Hardship and Poor Mental Health in Cancer: A Mixed Methods Study

PURPOSE: Administrative burdens are the extra steps a person must take to receive benefits from an institution. Examples include prior authorizations, denials of coverage, complex leave and accommodation policies, and paperwork to receive paid time off. METHODS: This mixed methods study explored the administrative burden among cancer survivors and the relationship of administrative burden to financial hardship and mental health. Data from three samples ranging from newly diagnosed to survivors were analyzed. RESULTS: Specific administrative burdens including prior authorization (moderate effect sizes) and surprise bills (moderate to large effect sizes) were most strongly associated with financial hardship but showed a weaker association with mental health (small effect sizes or nonsignificant results). Employment changes that have administrative burdens such as reducing work hours (effect sizes between small and moderate) were also strongly associated with financial hardship but showed weaker or nonsignificant associations with mental health. Not asking for reasonable accommodations was associated with less financial hardship than using accommodations (small to moderate effect sizes). Qualitative data suggested that avoidance of care and benefits were associated with burdens and that cumulative administrative burden could be associated with stress. Some burdens were specific to phase (treatment, survivorship), and avoidance and cumulative burden changed over time since diagnosis. CONCLUSION: Results support organizational and policy changes to remove bureaucratic barriers for people with cancer. Policy changes such as restrictions on prior authorizations and better insurance coverage of cancer and survivorship care could help mitigate the potential financial effects. Providing reasonable accommodations to all employees could help people with cancer work as much as they want and not experience financial hardship from using accommodations. Additional longitudinal research is needed to determine which policy changes could be most beneficial for people with cancer.