The number of persons in the United States with a history of cancer has increased from 3 million in 1971 to approximately 13.4 million in 2012, representing 4.6% of the population (
For this report, data from the 2008–2011 MEPS (annual response rate = 53.5%–59.3%) and the 2011 MEPS Experiences with Cancer Survivorship Survey (
Total annual medical costs, stratified by sex, were estimated using annual medical expenditures among cancer survivors and persons without a cancer history. The estimated total annual medical costs were also examined by source of payment and service type. Lost productivity was estimated by assessing employment disability (being unable to work because of illness or injury), health-related missed work days, and days spent in bed because of ill-health, stratified by sex. Multivariable logistic regression was used to estimate the percentage of those unable to work because of illness or injury, adjusting for age, sex, race/ethnicity, number of MEPS priority conditions, and education. Negative binomial regression was used to estimate missed work days and days in bed. All medical costs and productivity losses were adjusted to 2011 dollars.
Indicators of productivity loss among cancer survivors were also examined using data from the 2011 MEPS Experiences with Cancer Survivorship Survey, stratified by sex. The percentage of cancer survivors employed at any time since their diagnosis, changes in work because of cancer, and limitations in physical and mental tasks at work, productivity at work, and daily activities outside of work were estimated using multivariable logistic regression, adjusting for age, sex, race/ethnicity, and number of MEPS priority conditions.
What is already known on this topic?
Cancer survivors have increased risk for additional cancers and often experience lasting and late effects of treatment. The economic burden of illness, including medical expenditures and productivity losses, can be significant because half of the estimated 13.4 million cancer survivors are of working age.
What is added by this report?
From 2008 to 2011, male cancer survivors incurred average annual medical expenditures of approximately $8,000 per person and per capita productivity loss of $3,700. For female, the estimates were $8,400 for annual medical expenditures and $4,000 for per capita productivity loss. Among men, these estimates were nearly two times higher and for women they were one-and-half times higher than among persons without a cancer history. Nearly 32% of survivors experienced limitations in their usual daily activities outside of work because of cancer and, among those employed, an estimated 42% had to make changes to their work hours and duties.
What are the implications for public health practice?
As the population of cancer survivors increases, the economic impact of cancer for patients, families, employers, the health-care system, and society overall is expected to grow. Given the increased health-care needs and medical costs of cancer survivors, continued access to health care and ways to reduce disruptions in work and daily activities are important when survivors complete their cancer treatment. Such efforts could reduce the economic burden caused by cancer and could help maximize employment opportunities and productivity among cancer survivors.
Cancer survivors were more likely to be female, non-Hispanic white, in fair/poor health and insured and to have multiple chronic conditions compared with persons without a cancer history (
Among male cancer survivors, the per capita mean annual productivity loss was $3,719, compared with $2,260 among males without a cancer history (
Nearly one third of cancer survivors experienced limitations in their ability to perform usual daily activities outside of work, and 12% had impeded ability to perform mental tasks associated with usual daily activities (
The results of this analysis indicate that overall, cancer survivors had total annual medical expenditures estimated at $4,187 more for males and $3,293 more for females, compared with those of persons without a cancer history. These estimates were adjusted for age, sex, race/ethnicity, number of MEPS priority conditions, marital status, and education. These findings add to the growing concerns about the costs of cancer treatment and their negative impact on cancer survivors and their families. For example, a recent study reported that persons diagnosed with cancer are at higher risk for bankruptcy than those without a cancer history (
Many cancer survivors return to work and remain productive. However, for nearly a third of survivors, cancer and the lasting and late effects of treatment interfere with usual daily activities outside of work. Many of these survivors are in poor health. These survivors might be returning to work to maintain adequate health insurance coverage and to pay for cancer-related services not covered by insurance. For instance, approximately 10% of survivors aged <65 years in this analysis were uninsured (and therefore likely have incurred a larger personal financial burden) and might experience financial barriers to needed care than survivors who have some source of payment for medical services. The provisions of the Affordable Care Act are expected to help improve this situation by increasing access to health insurance for millions of persons living in the United States, including cancer survivors. Further, approximately 30% of survivors are disabled and not able to return to work or have decreased ability to work because of limitations in cognitive, mental, and physical functioning and psychological distress (
The findings in this report are subject to at least five limitations. First, because of inadequate sample size, these analyses were not stratified by cancer site or by time since diagnosis. Second, other aspects of economic burden of illness were not included, such as the time spent receiving medical care, productivity losses for caregivers, and intangible costs associated with pain and suffering from cancer and its treatment. Therefore, the reported medical and productivity costs represent only a portion of the total economic burden of cancer to society, survivors, and their families. Third, this analysis relied on self-report of cancer diagnosis, which was not verified by medical records, and household-reported survey data, which are subject to measurement errors (e.g., underreporting). Fourth, because the 2008–2011 MEPS response rates were <60%, the findings might reflect, in part, nonresponse bias. Finally, because the MEPS priority conditions were based on a count of 10 conditions, some of the burden attributable to cancer could be attributed to unmeasured comorbid conditions.
The data presented in this report summarize efforts of a new collaborative group, the Health Economics Research on Cancer Workgroup, to promote health economics research on cancer. The workgroup is composed of scientists from CDC, the National Cancer Institute, Agency for Healthcare Research and Quality, the American Cancer Society, Emory University, and the Livestrong Foundation. The workgroup seeks to address key research gaps identified in IOM reports (
With the projected increase in the number of cancer survivors, the economic burden of cancer will also likely increase (
Additional information available at
Characteristics of cancer survivors and persons without a cancer history — Medical Expenditure Panel Survey (MEPS), United States, 2008–2011
| 2011 MEPS Experiences with, Cancer Survivorship survey | 2008–2011 Core MEPS survey | |||||
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| Cancer survivor (n = 1,202) | Cancer survivor (n = 6,722) | No history of cancer (n = 86,865) | ||||
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| Characteristic | % | (95% CI) | % | (95% CI) | % | (95% CI) |
| 18–39 | 4.5 | (3.3–6.0) | 7.1 | (6.2–8.2) | 41.8 | (40.8–42.7) |
| 40–44 | 3.3 | (2.5–4.5) | 4.1 | (3.4–4.8) | 9.3 | (9.0–9.7) |
| 45–49 | 5.3 | (4.0–6.9) | 5.4 | (4.7–6.1) | 9.5 | (9.1–9.8) |
| 50–54 | 8.8 | (6.9–11.1) | 8.2 | (7.0–9.6) | 9.9 | (9.5–10.4) |
| 55–59 | 10.0 | (8.1–12.2) | 10.1 | (9.1–11.1) | 8.3 | (8.0–8.6) |
| 60–64 | 13.6 | (11.6–15.6) | 12.7 | (11.4–14.0) | 6.9 | (6.5–7.2) |
| 65–69 | 14.6 | (12.3–17.1) | 12.4 | (11.0–13.9) | 4.7 | (4.5–5.0) |
| 70–74 | 12.9 | (11.0–15.2) | 11.6 | (10.5–12.8) | 3.3 | (3.1–3.5) |
| 75–79 | 9.3 | (7.5–11.5) | 10.3 | (9.2–11.5) | 2.6 | (2.4–2.8) |
| ≥80 | 17.8 | (14.8–21.2) | 18.2 | (16.1–20.6) | 3.7 | (3.4–4.0) |
| Men | 42.5 | (39.3–45.8) | 41.8 | (40.0–43.6) | 49.0 | (48.6–49.4) |
| Women | 57.5 | (54.3–60.7) | 58.2 | (56.4–60.0) | 51.0 | (50.6–51.4) |
| White, non-Hispanic | 85.9 | (83.5–88.0) | 84.8 | (83.3–86.2) | 66.1 | (64.2–67.9) |
| Black, non-Hispanic | 6.6 | (5.4–8.0) | 6.9 | (6.1–7.9) | 11.9 | (10.7–13.3) |
| Hispanic | 5.1 | (3.8–6.7) | 5.3 | (4.5–6.1) | 14.9 | (13.4–16.6) |
| Other, non-Hispanic | 2.5 | (1.6–3.7) | 3.0 | (2.2–4.0) | 7.1 | (6.1–8.2) |
| Less than high school diploma | 13.0 | (10.9–15.5) | 15.6 | (14.2–17.0) | 16.9 | (16.2–17.7) |
| High school diploma | 29.8 | (26.8–32.9) | 31.7 | (30.0–33.5) | 29.5 | (28.7–30.3) |
| Some college or more | 57.1 | (53.6–60.5) | 52.5 | (50.4–54.5) | 53.2 | (52.1–54.3) |
| Married | 57.2 | (53.4–60.9) | 57.7 | (54.9–60.4) | 52.8 | (51.8–53.7) |
| Not married | 42.8 | (39.1–46.6) | 42.3 | (39.6–45.1) | 47.2 | (46.3–48.2) |
| 0 | 15.8 | (13.6–18.4) | 16.0 | (14.4–17.6) | 46.7 | (46.0–47.5) |
| 1 | 18.6 | (16.0–21.5) | 19.2 | (17.7–20.7) | 22.6 | (22.1–23.0) |
| 2 | 21.9 | (18.7–25.4) | 21.3 | (19.9–22.9) | 14.1 | (13.7–14.5) |
| ≥3 | 43.8 | (40.2–47.4) | 43.5 | (41.7–45.3) | 16.6 | (16.1–17.1) |
| Excellent/Very good | 41.4 | (38.0–44.9) | 39.6 | (37.8–41.3) | 60.0 | (59.1–60.8) |
| Good | 33.7 | (30.7–36.9) | 32.2 | (30.7–33.7) | 27.8 | (27.2–28.5) |
| Fair/Poor | 24.9 | (22.3–27.6) | 28.1 | (26.4–29.8) | 12.2 | (11.8–12.6) |
| Age <65 yrs, any private | 75.2 | (70.8–79.1) | 74.9 | (72.6–77.1) | 70.7 | (69.5–71.9) |
| Age <65 yrs, public only | 15.8 | (12.6–19.5) | 14.8 | (13.0–16.7) | 10.4 | (9.8–11.1) |
| Age <65 yrs, uninsured | 9.1 | (6.6–12.2) | 10.3 | (9.0–11.8) | 18.9 | (17.9–19.9) |
| Age ≥65 yrs, Medicare and private | 62.9 | (58.5–67.1) | 55.0 | (52.1–57.8) | 49.9 | (47.8–51.8) |
| Age ≥65 yrs, Medicare and public | 5.9 | (4.2–8.3) | 6.3 | (5.2–7.6) | 7.9 | (7.1–8.9) |
| Age ≥65 yrs, Medicare only | 30.4 | (26.4–34.7) | 37.8 | (35.2–40.5) | 40.8 | (39.0–42.6) |
Percentages are weighted using the MEPS Experiences with Cancer Survey weight.
In addition to cancer, MEPS priority conditions include arthritis, asthma, diabetes, emphysema, coronary heart disease, hypertension, stroke, high cholesterol, angina, and heart attack.
Annual medical expenditures and lost productivity
| Men | Women | |||||||||
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| Cancer survivor | No history of cancer | Cancer survivor | No history of cancer | |||||||
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| Characteristic | Adjusted mean | (95% CI) | Adjusted mean | (95% CI) | p-value | Adjusted mean | (95% CI) | Adjusted mean | (95% CI) | p-value |
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| Out of pocket | $751 | (686–816) | $600 | (579–620) | <0.001 | $973 | (904–1,042) | $833 | (807–860) | <0.001 |
| Private health insurance | $3,003 | (2,561–3,446) | $1,588 | (1,495–1,681) | <0.001 | $3,899 | (3,384–4,414) | $2,100 | (1,993–2,207) | <0.001 |
| Medicare | $1,845 | (1,556–2,134) | $1,025 | (950–1,100) | <0.001 | $1,816 | (1,651–1,981) | $1,356 | (1,270–1,442) | <0.001 |
| Medicaid | $556 | (305–808) | $294 | (236–352) | 0.005 | $720 | (566–875) | $484 | (442–525) | 0.001 |
| Other | $752 | (602–903) | $486 | (444–527) | <0.001 | $671 | (552–789) | $402 | (370–435) | <0.001 |
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| Ambulatory care | $2,640 | (2,344–2,936) | $1,151 | (1,102–1,200) | <0.001 | $3,187 | (2,896–3,478) | $1,689 | (1,621–1,758) | <0.001 |
| Inpatient care | $1,722 | (1,433–2,011) | $1,289 | (1,193–1,385) | 0.002 | $1,843 | (1,615–2,072) | $1,535 | (1,441–1,628) | 0.003 |
| Prescription medications | $1,343 | (1,138–1,549) | $1,077 | (899–1,116) | <0.001 | $1,650 | (1,479–1,820) | $1,186 | (1,141–1,231) | <0.001 |
| Other services | $745 | (641–848) | $646 | (607–685) | 0.072 | $917 | (819–1,015) | $827 | (779–874) | 0.071 |
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| Employment disability | $2,831 | (2,433–3,228) | $1,862 | (1,739–1,986) | <0.001 | $2,961 | (2,616–3,305) | $2,109 | (1,978–2,241) | <0.001 |
| Missed work days among employed persons | $597 | (461–734) | $267 | (252–283) | <0.001 | $686 | (585–787) | $393 | (374–413) | <0.001 |
| Lost household productivity | $291 | (229–353) | $131 | (112–150) | <0.001 | $386 | (318–453) | $201 | (184–217) | <0.001 |
Adjusted to 2011 dollars.
Estimates are adjusted predicted margins, pooling the MEPS survey weights, based on participants with no missing information for each response. Participants with the responses of “inapplicable,” “refused,” “not ascertained,” or “value assigned, but not collected” were excluded from the analysis. Regression models were adjusted for age (18–39, 40–44, 45–49, 50–54, 55–59, 60–64, 65–69, 70–74, 75–79, and ≥80 years), sex (male or female), marital status (married or not married), race/ethnicity (non-Hispanic white, non-Hispanic black, Hispanic, or non-Hispanic other), MEPS priority conditions (arthritis, asthma, diabetes, emphysema, coronary heart disease, hypertension, stroke, high cholesterol, angina, and heart attack), and education (less than high school diploma, high school diploma, or some college or more).
Indicators of productivity loss in cancer survivors — Medical Expenditure Panel Survey (MEPS) Experiences with Cancer Survivorship Survey, United States, 2011
| Total | Men | Women | ||||||
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| Indicator | No. | % | (95% CI) | % | (95% CI) | % | (95% CI) | p-value |
| Yes | 369 | 31.6 | (28.9–34.3) | 30.4 | (25.6–35.2) | 32.5 | (28.6–36.4) | 0.54 |
| No | 759 | 68.4 | (65.6–71.1) | 69.6 | (64.8–74.4) | 67.5 | (63.6–71.4) | |
| Yes | 154 | 11.6 | (9.7–13.6) | 10.2 | (6.9–13.5) | 12.5 | (9.6–15.4) | 0.35 |
| No | 982 | 88.4 | (86.4–90.4) | 89.8 | (86.5–93.1) | 87.5 | (84.6–90.4) | |
| Yes | 676 | 58.3 | (54.9–61.9) | 62.4 | (57.3–67.6) | 55.1 | (50.9–59.4) | 0.02 |
| No | 505 | 41.6 | (8.1–45.1) | 37.6 | (32.4–42.7) | 44.9 | (40.6–49.1) | |
| Yes | 285 | 42.1 | (37.9–46.2) | 33.7 | (26.7–40.7) | 48.2 | (42.3–54.1) | 0.01 |
| No | 344 | 57.9 | (53.8–62.1) | 66.3 | (59.3–73.3) | 51.8 | (45.9–57.7) | |
| Yes | 168 | 25.1 | (20.9–29.2) | 26.1 | (19.1–33.1) | 24.2 | (19.7–28.8) | 0.08 |
| No | 414 | 65.6 | (61.0–70.1) | 68.0 | (60.6–75.5) | 63.3 | (58.1–68.5) | |
| No physical tasks | 57 | 9.4 | (6.8–11.9) | 5.9 | (2.6–9.2) | 12.4 | (8.4–16.5) | |
| Yes | 103 | 14.4 | (11.4–17.3) | 11.5 | (6.7–16.3) | 16.3 | (12.3–20.3) | 0.17 |
| No | 545 | 85.6 | (82.7–88.6) | 88.5 | (83.7–93.2) | 83.7 | (79.7–87.7) | |
| Yes | 169 | 24.7 | (21.0–28.3) | 22.2 | (15.4–29.0) | 26.4 | (21.7–31.1) | 0.36 |
| No | 479 | 75.3 | (71.7–79.0) | 77.8 | (71.0–84.6) | 73.6 | (68.9–78.3) | |
Estimates are adjusted predicted margins, and 95% CIs using the MEPS Experiences with Cancer survey weight, based on participants with no missing information for each response. Participants with the responses of “inapplicable,” “refused,” “not ascertained,” or “value assigned, but not collected” were excluded from the analysis.
Regression models were adjusted for age (18–39, 40–44, 45–49, 50–54, 55–59, 60–64, 65–69, 70–74, 75–79, and ≥80 years), sex (male or female), marital status (married or not married), race/ethnicity (non-Hispanic white, non-Hispanic black, Hispanic, or non-Hispanic other), MEPS priority conditions (arthritis, asthma, diabetes, emphysema, coronary heart disease, hypertension, stroke, high cholesterol, angina, and heart attack), and education (less than high school diploma, high school diploma, or some college or more).
Estimates are based on participants who responded “yes” to the question, “At any time from when you were first diagnosed with cancer until now, were you working for pay at a job or business?”