The Cost of Cancer Should Reflect Impacts on Wellbeing, Productivity

The cost of cancer goes beyond financial expenditures for adolescent and young adult patients, extending into mental health impacts and workplace productivity losses, according to a report from the Journal of Clinical Oncology.

“The economic and human costs of cancer in AYAs are substantial, with the majority of costs borne by AYA cancer survivors in the United States themselves in the form of lost productivity, loss of well-being, and loss of life,” the report stated.

“The Cost of Cancer report results support the need to advocate for better treatment and access to care to reduce mortality rate in AYAs with cancer. AYAs will directly benefit from continued research on effective treatments, prevention strategies, and comprehensive insurance coverage options to ensure that adequate surveillance and health maintenance are affordable.”

The report analyzed 2019 data from the US Cancer Statistics Public Use Database. It focused on individuals between the ages of 15 and 39 years of age. The researchers also drew from the Surveillance, Epidemiology, and End Results Program and the Medical Expenditure Panel Survey from 2008 to 2012 using 2019 dollars.

Overall, the total cost of cancer for adolescent and young adult patients amounted to over $199.5 billion. The researchers found that the cost of young adult cancer treatment largely consisted of healthcare system costs, particularly for fertility preservation, productivity costs due to mortality and loss of workforce participation, loss of well-being, and additional costs.

Healthcare system costs equaled $3.23 million. Hospitals bear the brunt of the health system costs for young adults with cancer (44.9 percent), followed by care settings outside of the hospital (38.1 percent). Prescription drugs consume nearly 12 percent of the cost and fertility preservation takes up nearly 5 percent.

The cost of lost productivity amounted to over $18 billion. Most productivity costs are tied to young deaths. Premature mortality contributes $119,400 per person to total spending for a total of $10.8 billion, the highest productivity cost related to young adult cancer diagnoses. The second highest driver of productivity costs was diminished engagement in the workforce ($2.5 billion).

Presenteeism—the inability to fully contribute while at work—was responsible for higher costs than absenteeism, which might explain in part why seven out of ten employers have designed wellness programs around presenteeism.

Well-being can also be expensive when managing cancer treatment for young adults. The researchers calculated loss of well-being using disability-adjusted life years. This number estimates the number of years lost due to premature death and the years that the patient lived with their disability.

Loss of well-being turned out to be the biggest driver of cancer costs in adolescents and young adults when compared to the other spending categories that the researchers analyzed. The total cost exceeded $96 billion.

A young adult between the ages of 35 and 38 who has cancer is in the costliest subgroup of young adult cancer patients for well-being costs ($36.5 billion). Specifically, women in this group contributed to the high cost—the cost of treating female patients between the ages of 35 and 39 was more than $21.6 billion.

The researchers pointed out that certain related topics required further study—namely, the work-related side effects of prolonged maintenance therapies, analyses of wellbeing loss, the cost impacts on informal caregivers, how the transition to outpatient or home-based care has affected wellbeing, out-of-pocket healthcare spending, and productivity loss for both patients and caregivers.

“The economic and human costs of cancer in AYAs are substantial, with the majority of costs borne by AYA cancer survivors in the United States themselves in the form of lost productivity, loss of well-being, and loss of life,” the researchers explained.

“The Cost of Cancer report results support the need to advocate for better treatment and access to care to reduce mortality rate in AYAs with cancer. AYAs will directly benefit from continued research on effective treatments, prevention strategies, and comprehensive insurance coverage options to ensure that adequate surveillance and health maintenance are affordable.”

“It may be time for the creation of a US-based AYA national registry with consistent follow-up across all diagnoses,” the researchers concluded.

Medicaid beneficiaries with cancer are particularly susceptible to barriers in access to care.