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The Cost and Financial Burden of Thyroid Cancer on Patients in the USA Review and Directions for Future Research

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Importance  In the US, thyroid cancer has been identified as a cancer type with a high degree of associated financial burden on patients, and survivors of thyroid cancer report higher rates of bankruptcy than those of other cancer types. However, the available literature on the financial burden of thyroid cancer has not yet been described.

Observations  Estimates of the out-of-pocket costs of initial thyroid cancer diagnosis and treatment range widely ($1425-$17 000) and are influenced by age, surgical treatment type, and health insurance coverage. The rates of patient-reported financial burden are heterogeneous (16%-50%) and are rarely compared with those of other cancer types. Independent risk factors of financial burden have included younger age, lack of health insurance, and annual household income of less than $49 000. Two studies measured medical debt associated with thyroid cancer diagnosis and treatment at notably different rates (2.1% vs 18.7%). The bankruptcy incidence at 1 year after cancer diagnosis is highest for thyroid cancer (9.3 per 1000 person-years) than other studied cancer types (ie, lung, uterine, leukemia/lymphoma, colorectal, melanoma, breast, prostate) and 4.39-fold higher than control individuals among those aged 35 to 49 years.

Conclusions and Relevance  Current estimates of the financial burden of thyroid cancer are methodologically limited and are based on cross-sectional analyses of patient-reported data. We propose novel frameworks for new research by improvements in (1) data sourcing and utilization, (2) study design, and (3) pilot interventions. To understand how out-of-pocket thyroid cancer-related expenditures transition to various forms of debt, how households finance ongoing costs of care, and rates at which debts are sent to collection agencies, future research should focus on integrating underutilized sources of primary data, including credit reports, public records, and mortgage-backed securities loan-level data. Improvements in study design, such as the development of prospective cohorts, can allow for more objectively measured estimates of out-of-pocket costs, and robust covariate analysis can further reveal the influence of demographic factors, including age, sex, race, income, and health insurance coverage. Finally, new pilot interventions on cost controls can both enable further study and alleviate financial burden.

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Article Information

Accepted for Publication: March 19, 2022.

Published Online: May 5, 2022. doi:10.1001/jamaoto.2022.0660

Corresponding Author: Benjamin James, MD, MS, Section of Endocrine Surgery, Division of Surgical Oncology, Department of Surgery, Beth Israel Deaconess Medical Center, 185 Pilgrim Rd, Palmer 605, Boston, MA 02115 (bjames1@bidmc.harvard.edu).

Author Contributions: Dr Uppal had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Uppal, James.

Acquisition, analysis, or interpretation of data: Uppal, James.

Drafting of the manuscript: Uppal, James.

Critical revision of the manuscript for important intellectual content: Uppal, James.

Statistical analysis: Uppal.

Administrative, technical, or material support: James.

Supervision: James.

Conflict of Interest Disclosures: Dr Uppal reports income from Quantifed Ventures and Ironwood Medical Information Technologies outside of the submitted work. No other conflicts were reported.

Funding/Support: This work was supported by the National Institutes of Health (NIH)/NCI R37 CA231957 (Dr Cunningham).

Role of the Funder/Sponsor: The National Institutes of Health had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

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