(Reuters Health) - Cancer survivors have higher-than-average rates of medical financial hardship, a U.S. study suggests.

Medical financial hardship includes problems paying bills and other challenges with money; psychological stress like intense worry over unpaid bills; and behavioral issues like delaying needed care because of cost.

Cancer survivors ages 18 to 49 appeared hardest hit by these problems. About 43 percent had health-related money problems, compared to 30 percent of their counterparts who never had cancer, and 31 percent delayed care due to costs, compared to 21 percent of average people this age.

“Although cancer patents have benefited from newer and more advanced treatments, financial hardship may lead to emotional distress, cause changes in health behaviors, and jeopardize treatment adherence and health outcomes,” said lead study author Zhiyuan “Jason” Zheng of the American Cancer Society in Atlanta.

Young adults may struggle the most because cancer might interrupt their education and limit their access to employer-provided health insurance, Zheng said by email. This can have devastating health effects and lead patients to also face challenges like food and housing insecurity, he added.

“We already knew that extreme financial insolvency, i.e. bankruptcy, increases the risk of early mortality among cancer survivors,” Zheng said. “Although we don’t know the exact pathways, it has been hypothesized that financial hardship can cause high stress among cancer survivors, force some patients to be non-adherent to treatments to save money, and lower their overall quality of life.”

Newer cancer drugs can cost upwards of $10,000 a month, compared with an average of $1,000 a month 20 years ago, the study authors note. Patients are also picking up an ever larger share of the tab in co-payments, deductibles and other out-of-pocket costs.

As reported in Cancer, the researchers examined data on 4,340 adult cancer survivors under 65 plus 98,692 people the same age who never had cancer. They also looked at 6,014 survivors age 65 and older, plus 25,744 older adults without cancer.

Most of the survivors had been diagnosed at least a decade earlier. About two-thirds of them had insurance through employers or another type of private health coverage.

The study wasn’t a controlled experiment designed to prove whether or how cancer survivors’ medical costs might directly impact their health. Researchers also lacked detailed clinical data about patients’ exact diagnoses and treatment histories.

Even so, the results add to mounting evidence suggesting that cancer survivors experience more money issues related to their diagnosis than people with other chronic health problems, said Dr. Ryan Nipp, a researcher at Harvard Medical School and Massachusetts General Hospital in Boston who wasn’t involved in the study.

“Patients and families should openly discuss any and all concerns, particularly financial concerns, early and often with the clinicians caring for them,” Nipp said by email. “Clinicians can refer patients to social workers, financial counselors, or patient navigators, depending on their availability, to try to help.”

This is especially important for younger individuals, said Dr. Alana Biggers of the University of Illinois at Chicago, who wasn’t involved in the study.

“Young cancer survivors have to deal with the financial difficulties associated with being a Gen Xers or millennials in addition to the financial burden of healthcare costs,” Biggers said by email. “Gen Xers and millennials are burdened with student loan debt and credit card debt; many are starting families and may have their first mortgage; additionally, younger people may have opted to have an insurance plan with a lower premium and a high deductible or co-payments.”

SOURCE: bit.ly/2sBt05X Cancer, online January 21, 2019.