Abstract A77: Patterns of medical utilization, finances, health behaviors and comorbidities in older adults reporting negative versus positive net worth after a cancer diagnosis
Authors: Castellanos Emily , Richards Michael 
Published: March 2017

Abstract
Purpose:
Financial insolvency following cancer has been linked to increased mortality; however, the individual financial factors, insurance, medical utilization, health behaviors, and comorbidities in cancer patients with a negative net worth (NNW) have not been characterized. Using the Health and Retirement Study, a national longitudinal survey of U.S. households from 1992 to 2012, we examined the effect of a cancer diagnosis on medical spending and personal finances in adults age-eligible for Medicare insurance. Demographic variables, insurance status, and measures of medical utilization, finances, and health in cancer patients reporting negative and positive net worth were assessed.
Methods:
Analyses were restricted to individuals age 65 years or older to reduce heterogeneity in employment and insurance status. Individual-level fixed effect panel analyses were performed to assess the effect of a cancer diagnosis on log out-of-pocket medical spending, hospitalizations, log household debt, Medicaid enrollment, and NNW. Subset analyses were performed by gender and time period (pre- and post-2002). Summary measures of cancer patients, partitioned by presence or absence of NNW, were performed on financial indices, medical utilization, health measures, and insurance.
Results:
A new cancer diagnosis significantly increased out-of-pocket medical spending, hospitalizations, Medicaid enrollment, and risk of NNW in all respondents, as well as household debt in males. Following a cancer diagnosis, there was a large change in medical utilization, with a 36.7% increase in log out-of-pocket medical spending and a 71.4% increase in hospitalizations (p&lt;0.01). Log household debt increased by 22.1% in male cancer patients (p&lt;0.05); there was no significant change to household debt for female cancer patients. There was a small but statistically significant increase in risk of financial insolvency and Medicaid enrollment following a cancer diagnosis (1.3% and 1.2%, respectively; p&lt;0.05); on subset analysis, risk of developing a NNW after cancer appeared to be highest in women and in the post-2002 era. Out of 2682 cancer patients, 183 (6.8%) reported NNW. Compared to cancer patients with positive net worth, the NNW group had less education, higher likelihood of being widowed, divorced, or unmarried, higher percentage non-white race and Hispanic ethnicity, higher rates of disability, higher Medicaid enrollment, and less private insurance. While median out-of-pocket medical spending was lower in financially insolvent cancer patients, this group had increased hospitalizations and cumulative length of hospital stays. Smoking rates and body mass index were similar between the two groups, but patients with NNW had worse clinical depression and self-reported health scores, as well as increased rates of hypertension, cerebrovascular disease, diabetes, pulmonary disease, arthritis, and mental illness.
Conclusion:
A diagnosis of cancer increases out-of-pocket medical spending, hospitalizations, and financial insolvency among individuals age-eligible for Medicare insurance protection. Newly diagnosed cancer patients reporting negative net worth have multiple differences in socioeconomic status, medical utilization, and comorbidities as compared to patients with positive net worth, which may contribute to disparities in survival outcomes.
Citation Format: Emily Castellanos, Michael Richards. Patterns of medical utilization, finances, health behaviors and comorbidities in older adults reporting negative versus positive net worth after a cancer diagnosis. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr A77.