WHO ARE CANCER SURVIVORS?

The number of cancer survivors living in the United States continues to increase each year as a result of the growth and aging of the population, as well as increases in survival due to changes in early-detection practices and treatment advances. The survivor population represents a diverse range of experiences with cancer. Information about current treatment patterns and cancer survivorship issues can help the public health community meet the needs of this expanding and heterogeneous population.

Cancer prevalence is defined as the total number of cancer survivors living in a population. In this report, the term “cancer survivor” refers to any person with a history of cancer, from the time of diagnosis through the remainder of their life. However, many people with a history of cancer do not identify with the term “cancer survivor.”

The definition of cancer survivorship has evolved from a focus on three phases (the time from diagnosis to the end of initial treatment, the transition from treatment to extended survival, and long-term survival) to encompass a wide range of experiences and trajectories. For example, some individuals may live cancer free for the remainder of their life after initial treatment, while others may live with cancer as a chronic disease or experience recurrence or a subsequent cancer.

FINANCIAL HARDSHIP AMONG CANCER SURVIVORS

Cancer survivors are vulnerable to financial hardship that may manifest as material (e.g., problems paying medical bills, medical debt, and bankruptcy), psychological (e.g., stress or worry about paying medical bills), or behavioral (e.g., delaying or forgoing necessary medical care because of cost) aspects. Survivors who are younger, underinsured or uninsured, and/or have lower income are more likely to experience financial hardship, as are long-term survivors of childhood cancer. For example, in one study, 35% of cancer survivors ages 18-49 years reported difficulty in paying medical bills compared to 25% in those without a history of cancer; this gap narrowed substantially in ages 50-64 years, 27% versus 23%, respectively.147 Younger cancer survivors are also more likely to report multiple aspects of financial hardship and greater hardship intensity than older cancer survivors. Medical financial hardship is most prevalent among cancer survivors without health insurance. Even when survivors have private or government health insurance, out-of-pocket costs of cancer care often pose a significant financial burden for them and their families that continues long after initial treatment is completed.