Cancer survivors are more likely to have difficulty accessing and affording healthcare compared with adults without cancer. However, the proportion of survivors reporting these difficulties decreased in the years after the implementation of the Affordable Care Act (ACA), suggesting access and affordability improvements occurred because of healthcare reform, according to the results of a study published in JAMA Oncology.

Ryan D. Nipp, MD, MPH, from Massachusetts General Hospital and Harvard Medical School in Boston, and colleagues used data from the National Health Interview Survey from 2010 through 2016 to conduct a population-based study in 30,364 American adults. Cancer survivors made up half the group; the rest had no history of cancer and served as control patients. The average age of participants was 63.5 years. Cancer survivors were more likely than control patients to be insured (94.8% vs 92.2%; P <.001) and to have government-sponsored insurance than control patients (44.3% vs 38.8%; P <.001).

Despite being more likely to have insurance, cancer survivors had increased odds of delayed care (odds ratio [OR], 1.38), to have forgone medical care (OR, 1.76), and/or to have experienced the inability to pay for medications (OR, 1.77) and healthcare services (OR, 1.46; P <.001 for all). However, from 2010 to 2016, each year, a decreasing proportion of cancer survivors reported delaying medical care or needing and not receiving medical care. Likewise, the proportion of survivors reporting that they were unable to afford prescription medication also decreased each year, as did the proportion of those unable to afford healthcare services.

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Among the study’s limitations is use of a cross-sectional analysis of annual surveys over repeated years, precluding determination of the directionality of the associations they observed. Also, as the same participants are not included in each year’s survey, changes within participants could not be assessed. Another limitation is the use of self-reported questionnaires, which may contain questionable data based on the ability of the participant’s recall. The authors suggested that cancer survivors may be more likely to report problems with healthcare access and affordability than control respondents, as they may be more focused on healthcare issues.

The authors argue that their results provide important evidence of efficacy associated with the implementation of the ACA during this time of debate about healthcare reform.


Nipp RD, Shui AM, Perez GK, et al. Patterns in health care access and affordability among cancer survivors during implementation of the Affordable Care Act [published online March 29, 2018]. JAMA Oncol. doi: 10.1001/jamaoncol.2018.0097.