Christopher Su, MD, University of Michigan, Ann Arbor, discusses results from a study investigating the differences in costs and care utilization between blood cancer survivors and solid cancer survivors, and examining what their survivorship looks like.

These results were presented at the 2021 virtual National Comprehensive Cancer Network (NCCN) Annual Conference.

Transcript:

Hello, my name is Christopher Su, and I'm currently one of the hematology/oncology fellows at the University of Michigan.

I'm going to be talking about my study, "Health Care Utilization Between Blood and Solid Cancer Survivors and Implications for Financial Toxicity: Results from the National Health Interview Survey 2009 to 2018," which was presented as an oral presentation at the NCCN annual conference in March.

The background that drove us to look at this is we are very interested to study the differences in how blood cancer survivors and solid cancer survivors utilize care and what their survivorship looks like. Blood cancer patients only comprise of about 10% of all cancers, with the other 90% being solid cancers.

As a result, the current studies looking at financial toxicity and care utilization in cancer survivors and cancer patients usually group all of the cancers together. We believe that this doesn't uniquely capture the experience of the blood cancer patients.

We decided to use the annual National Health Interview Survey to help us answer this question. In order for us to do this, we went into NHIS, which was an annual national cross-sectional survey focused on the status of respondent health and the provision of health care.

It's an annual survey that's administered by the CDC since 1957. We extracted out data from the last 10 years, from 2009 to 2018, and we identified the respondents with solid cancers and the respondents with blood cancers.

We then grouped them into two different cohorts. The first cohort being their diagnosis within the last 2 years, and then another cohort being their diagnosis within the last 10 years. We thought by having two time cohorts that would also help us uniquely capture the immediate picture of care utilization and financial toxicity, versus a more long-term approach of financial toxicity and care utilization.

After the two cohorts were identified, we ended up with about 300 blood cancer survivors in the under-2-year cohort and about 790 respondents with blood cancers in the 10-year cohort. The corresponding solid cancer numbers are about 4,800 in the less-than-2-year cohort and about 12,000 in less-than10-year cohort.

As you can see, the numbers really trended to be about 10% for the solid cancer patients when you look at all of the cancer survivors. We looked at the baseline statistics. We pulled out some variables that were significantly different across the two cohorts, namely, age, sex, and also baseline health.

Respondents with blood cancers tend to have poor baseline health compared to the solid cancer respondents. Then we identified survey questions that are in NHIS that had to do with financial toxicity and care utilization.

What we found was that the blood cancer respondents utilized significantly more health care in terms of going to the hospital, being hospitalized, seeing the outpatient providers in clinic, compared to their solid cancer counterparts in both cohorts.

The relationship was persistent both in the respondents that had their diagnosis under 2 years, and also the respondents that had their diagnosis under 10 years. Also, these respondents were more likely to report that they were worried about medical care and how to pay for medical care.

The blood cancer respondents said that they were more worried about medical costs and more worried about medical bills compared to their solid cancer counterparts. We thought that this was very interesting, because as a clinician, we do see that these blood cancer patients have to come back a lot for checkups, for routine lab appointments.

We imagine a lot of these costs will add up over time, so we were very interested that our data did show that these blood cancer respondents ended up utilizing more care and said that they were more worried about their cost of care compared to solid cancer respondents.

What we didn't find when we looked at some of the other measures that look specifically at the respondent saying that they had their care delayed due to cost or that they took less medication due to cost, the blood cancer respondents actually reported that they didn't do these things.

Even though they were more worried about the cost of care, they didn't actually affect behavior that directly changed how they were managing their disease, such as taking less medication or going to the doctor less often.

This is a relationship that we were also very interested in that we noted when we did this study. It's probably very difficult to really ascertain these relationships in the context of a large database retrospective study.

We certainly think that there are many avenues to approach in a prospective study that could tease out some of these nuances about the relationship between care utilization, the worry and the distress that is associated with obtaining care, and their actual behavior changes that patients might have when they're faced with these kinds of challenges, in terms of having to pay a lot of money to go see the provider or to pay a lot of money because they had to be hospitalized so often.

Some of the limitations in our study include that NHIS is not a cancer-specific database. There's no linked treatment or clinical data. The care that's received is not specific to cancer. Although, we do believe that it's indicative of general health status and paints a good picture of the respondent's overall health, which is influenced by their cancer diagnosis.

Finally, we cannot parse out many different cancer subgroups within the NHIS. We have leukemia, lymphoma, and other blood cancer, and that's the three categories that we have.

Some of the future directions that we're doing right now is that we're trying to propose some prospective approaches to really tease out these fine relationships among a diverse representative sample of blood cancer patients, both in academic health centers, and also in more community practices to see in a real-life setting what are some of the challenges that this survey was able to hint at.

We're able to tease out the signals. Right now, we're just really trying to see what the true challenges are and why these blood cancer patients are needing more care and what is the financial impact that they're experiencing.

Thank you. Thank you for your time, and it was a pleasure to speak to you about our project. Thanks.   

Su C, Patel M. Healthcare Utilization Between Blood and Solid Cancer Survivors and Implications for Financial Toxicity: Results From the National Health Interview Survey, 2009-2018. Presented at: the NCCN 2021 Virtual Annual Conference; March 18-20, 2021. Abstract HSR21-071.

Dr Su reports no relevant financial relationships.