Substantial Medical Debt, Bankruptcy Linked to Thyroid Cancer

Pam Harrison

May 09, 2022

Patients with thyroid cancer may experience greater financial challenges compared to those with other common cancers, a recent review suggests.

Researchers found, for instance, that patients with thyroid cancer had higher total yearly healthcare expenditures, on average, compared to patients with other types of cancer ($9585 vs $5830), and rates of bankruptcy were higher.

The review was published online May 5 in JAMA Otolaryngology–Head and Neck Surgery.

Research on the costs associated with cancer care indicate that thyroid cancer, in particular, comes with a significant financial burden for patients and survivors.

In the current review, Benjamin James, MD, Beth Israel Deaconess Medical Center, Boston, and colleagues evaluated all known studies on the financial burden of thyroid cancer to capture the evidence to date and identify knowledge gaps.

Among the studies included, James and co-authors found that estimates of the out-of-pocket costs for thyroid cancer diagnosis and treatment varied considerably, from $1425 to as high as $17,000 in the first year after being diagnosed. Medical debt associated with thyroid cancer care varied from about 2% to almost 19%.

These costs were influenced by a range of factors, including cancer stage, health insurance coverage, and age. For instance, patients who underwent total thyroidectomy for malignant disease experienced higher median costs ($29,171 vs $17,335) and out-of-pocket costs ($3019 vs $2271) compared to their peers with benign disease. Out-of-pocket costs varied by health insurance type. The greatest costs were incurred by patients with high-deductible health plans ($4265), and the lowest for those with health maintenance plans ($1529).

Bankruptcy rates among patients with thyroid cancer were notable as well. In one study, 41% of patients filed for bankruptcy 5 years after being diagnosed. Another analysis found that the bankruptcy incidence 1 year following a cancer diagnosis was highest for thyroid cancer (9.3 per 1000 person-years) compared with other cancers — specifically, lung, leukemia/lymphoma, colorectal, melanoma, breast, prostate, and uterine cancers — even though thyroid cancer "typically requires comparatively less extensive treatment," the authors note. In this study, younger patients were more likely to file for bankruptcy.

Among cancer survivors, one analysis found that three times more survivors of thyroid cancer reported being in debt or borrowing money (19% vs 6%) compared with patients with breast, prostate, colon, or lung cancer. Survivors of thyroid cancer were two times more likely to be uninsured (5.4%) compared with patients with breast, prostate, colon, or lung cancer (2.4%). Lack of insurance coverage increased the risk of material financial hardship by sevenfold.

The financial burden associated with thyroid cancer can affect patients' mental health and employment as well. Results from the Thyroid Cancer Survivors' Association cohort study showed that experiencing thyroid cancer–related financial challenges was associated with worse anxiety, depression, and social functioning.

That study also found that 18% of patients reported being unemployed for at least 6 months, and 42.5% reported less work-related income owing to thyroid cancer care. To manage these out-of-pocket costs, almost one quarter reported using most or all of their savings, and about 16% were contacted by a collection agency.

Despite the growing body of evidence on the financial burden associated with thyroid cancer, minimal data exist regarding the ways in which these financial obligations accumulate and how employment and insurance coverage may change over time.

Even if highly reliable, these estimates "represent an incomplete proxy of the true financial burden borne by patients," the authors note. "Further research is needed to examine how the accumulation of debt over time affects employment, insurance coverage, health outcomes, and bankruptcy."

The study was supported by the National Institutes of Health. James has disclosed no relevant financial relationships.

JAMA Otolaryngol Head Neck Surg. Published online May 5, 2022. Abstract

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