Younger Cancer Survivors Reduced Prescription Drug Use for Financial Reasons

Many non-elderly cancer survivors may change their prescription drug use for financial reasons, according to the results of a study published in Cancer. Changes in behavior include skipping doses of medication or requesting cheaper medications.

“We observed that both recently and previously diagnosed cancer survivors in the United States are more likely to alter their prescription drug use for financial reasons compared with individuals who do not have a history of cancer,” wrote Zhiyuan Zheng, PhD, of the Surveillance and Health Services Research with the American Cancer Society, and colleagues. “Healthcare policies that help cancer survivors address the financial burden of prescription drugs should target those who have multiple comorbid conditions and high-deductible health plans.”

Zheng and colleagues used data from the 2011 to 2014 National Health Interview Survey to measure changes in prescription drug use for financial reasons. They identified 8,931 adults with a history of cancer and 126,287 adults without cancer. Possible reasons for changes in prescription drug use included skipping doses, taking less medicine, delaying filling a prescription, asking for a lower-cost medication, buying drugs from another country, or using alternative therapies.

The researchers found that non-elderly cancer survivors were more likely to report changes in prescription drug use for financial reasons compared with non-elderly adults without cancer. Specifically, 31.6% of survivors recently diagnosed and 27.9% of survivors previously diagnosed reported any change in prescription drug use because of financial reasons compared with 21.4% of those without a history of cancer.

“Cancer survivors have been reported to have difficulties living within their household income, accrued debt, sold or refinanced their home, borrowed money from friends or family, or experienced a decline ≥ 20% in annual income because of treatment-related expenses,” wrote the researchers. “Our findings are consistent with the literature indicating that younger age is associated with increased risks of cancer-related financial problems and higher rates of personal bankruptcy because of medical bills.”

In addition, data showed that non-elderly survivors were more likely to report changing prescription drug use for financial reasons when there was one or more comorbid condition(s) among recently diagnosed patients, or two or more comorbid conditions among previously diagnosed patients.

Elderly survivors and adults without cancer had similar rates of changes in prescription drug use for financial reasons when stratified by the number of comorbid conditions.

“Although elderly cancer survivors are likely to take more prescription drugs than elderly individuals without a history of cancer and may forgo expensive cancer drugs for financial reasons, we did not observe systematic differences in the probabilities of reporting changes in prescription drug use for financial reasons between them,” noted the researchers. “This is likely because of the near universal enrollment in Medicare, including prescription drug coverage for many, which may reduce the impact of medication cost on drug use.”

Finally, non-elderly cancer survivors enrolled in high-deductible plans were more likely to ask their doctor for lower-cost medications compared with those enrolled in low-deductible plans (odds ratio, 1.71; 95% CI, 1.32–2.22).

In an editorial that accompanied the article, Daniel A. Goldstein, MD, of Davidoff Cancer Center at Rabin Medical Center in Petach Tikvah, Israel, wrote, “All physicians must recognize that financial toxicity is a serious issue, not to be denied or ignored. Although financial toxicity has become accepted by most, there remain subsections of the medical community that deny its existence-somewhat analogous to climate change denial. Only by starting with acceptance can we begin to look for solutions.”