Post-COVID changes to healthcare utilization, expenditures, and care prioritization among US cancer survivors.

Abstract

e23131 Background: The COVID-19 pandemic disrupted cancer care delivery, leading to adaptations. We examined cost burden (CB), medical debt (MD), total healthcare expenditures (THE), out-of-pocket (OOP) costs, and forgone/delayed care (FoDC) among US cancer survivors (CanS) following COVID. Methods: Using a nationally representative Medical Expenditure Panel Survey (MEPS), we identified adult CanS in pre-COVID (PRE) (2018 & 2019) and post-COVID (POS) (2022 & 2023) eras. Outcomes included CB (OOP costs >10% of family income, or >5% if income <200% federal poverty level), MD (inability to pay medical bills or doing so over months), and FoDC (inability to afford or delay care or prescriptions). Survey-weighted chi-square and Wilcoxon rank-sum tests compared variables. Expenditures were inflation adjusted. Multivariable (MVA) Quasi-Poisson regression adjusting for age, sex, race, insurance, poverty, spouse status and COVID era identified predictors of THE and OOP costs. All analyses used survey design and were weighted. P < 0.05 was significant. Results: A total of 3,880 PRE (weighted (w): 20,309,197) and 3,346 POS (w: 21,766,685) CanS were identified. Prevalence of CB in PRE and POS CanS was 11%. Reported MD was lower POS among all-comers (18% vs 22%; p<0.01), and across all races, but more pronounced in Hispanic (18% vs 27%) and Black individuals (20% vs 29%). Patients with only public insurance experienced less MD POS (17% vs 23%) as did those never married (16% vs 26%). In adjusted regression, Younger CanS (18-45) (adjusted relative risk (aRR) 0.3, ref = 65+) and Hispanic (aRR 0.5) and Black (aRR 0.6) CanS (ref = white) were less likely to experience CB, while both privately insured (aRR 2) and private + Medicare (aRR 1.3) experienced more CB compared to public only insurance (all p <0.01). In MVA, THE was higher POS by $4,000 per CanS (p<0.01) while OOP costs remained unchanged. Female CanS (aRR 1.4), younger (18-45) (aRR 2.4) and middle-aged (45-64) CanS (aRR 2) compared to those 65+, CanS without a spouse at home (aRR 1.4), CanS experiencing CB (aRR 1.6), and poor CanS (aRR 1.78) were more likely to report FoDC while POS CanS (aRR 0.7) were less likely to report FoDC. Conclusions: This is the first nationwide study to examine changes to CanS priorities and healthcare spending after the COVID pandemic. POS CanS experienced higher THE, while risk of CB and OOP costs remained unchanged, suggesting that the decrease in MD, likely due to pandemic-era financial relief policies and improved access to cancer care with telehealth and other Cancer Moonshot initiatives, might have led to the decreased rates of FoDC among CanS. Despite population-level improvements, younger and middle-aged CanS and female CanS remain at risk of forgoing care when forced to prioritize. These findings underscore the need for targeted interventions to address persistent disparities among vulnerable CanS.