Financial burden of high-cost immunotherapy among cancer survivors in Medicare.

Purpose: Cancer survivors often experience significant financial hardship, which is exacerbated by the rising costs of novel immunotherapies. This study examined the association between financial hardship and receipt of high-cost immunotherapy among cancer survivors.

Methods: We used data from the 2010-2020 Health and Retirement Study linked to Medicare Part B and D claims to examine cancer survivors aged 65 and older who received infusion and oral immunotherapy. Adjusted linear probability models assessed the relationship between high-cost treatment and key outcomes, including reported debt, inability to afford medical care, reduced medication use due to cost, and high out-of-pocket expenses.

Results: Among all cancer survivors, we found that high-cost immunotherapy significantly increased the likelihood of financial hardship, including a 7.2 percentage point (pp) increase in the inability to afford medical care (95% confidence intervals (CI), - 0.011 to 0.156; P = 0.089). Blood cancer survivors experienced greater financial hardship than those with solid tumor cancers. Specifically, blood cancer survivors experienced a 23.8 pp (CI, 0.013 to 0.463; P = 0.038) increase in the inability to afford medical care and a 42.7 pp (CI, 0.148 to 0.706; P = 0.003) increase in taking fewer medications than prescribed.

Conclusions: High-cost immunotherapy increased the risk of cancer survivors reporting an inability to afford care and taking fewer medications due to cost. Blood cancer survivors were more likely to report financial hardship compared to those diagnosed with solid tumors.

Implications for cancer survivors: These results underscore the need for interventions to alleviate economic burdens and improve access for patients receiving high-cost cancer treatments.