Examination of insurance type and cancer treatments with administrative burdens and financial toxicity in a sample of cancer survivors.

PURPOSE: Many cancer survivors experience administrative burdens and poor financial outcomes but associations with insurance and cancer treatments are not well studied. This study aimed to fill that gap.

METHODS

Cancer survivors (n = 459), on average 11 years post-diagnosis and in the United States completed a cross-sectional survey. Dependent variables were five types of insurance-related administrative burdens (prior authorization, denials, surprise bills, stepped care, out-of-network care) and four dimensions of financial toxicity. Independent variables were health insurance type at diagnosis and cancer treatments. Logistic and linear regression models assessed the relationships between independent and dependent variables.

RESULTS

Forty-six percent reported at least one insurance-related administrative burden. Participants who received immunotherapy (prior authorizations: 33%; surprise bills: 46%; stepped care: 26%), chemotherapy (denial: 22%; stepped care: 17%), surgery (surprise bills: 33%; out-of-network: 16%) and radiation therapy (denials: 24%) reported significantly higher prevalence of administrative burdens than those who had not received those treatments (p's < 0.05). Insurance type was not associated with administrative burdens (p's > 0.05). Surgery, chemotherapy and immunotherapy were associated with more financial coping than those who did not receive these treatments (p's < 0.025). Compared to employer/school-sponsored insurance, most insurance types were not associated with financial toxicity except self-purchased insurance was associated with more financial depression, anxiety and coping (p's < 0.05).

CONCLUSIONS

Patient-reported administrative burden may be associated with all types of insurance and survivors may respond with more financial coping.

IMPLICATIONS FOR CANCER SURVIVORS: Immunotherapy and chemotherapy may have the highest risk for administrative burdens but surgery and radiation therapies can also confer risk.