Risk-based financial navigation targeting among U.S. cancer survivors before the Medicare Part D out-of-pocket cap: MEPS 2017–2023.

Abstract

32 Background: Financial toxicity remains a major challenge for cancer survivors. We evaluated financial hardship among U.S. cancer survivors before implementation of the Medicare Part D out-of-pocket (OOP) spending cap and developed a risk-based framework for targeted financial navigation. Methods: We pooled 2017–2023 Medical Expenditure Panel Survey (MEPS) data (n=188,344 adults; 16,926 cancer survivors). Financial hardship was defined as either high OOP burden (>10% of family income) or a cost-related prescription barrier (delayed or foregone medication). Survey-weighted logistic regression estimated adjusted odds of hardship among cancer survivors versus non-cancer adults. Analyses were stratified by age, race/ethnicity, insurance status, cancer site, and geographic region. Targeting efficiency was evaluated using hardship cases identified per survivor screened and the number needed to screen (NNS). Results: Financial hardship affected 13.9% of cancer survivors versus 8.0% of non-cancer adults (adjusted OR 1.31, 95% CI 1.21–1.41). Disparities were greatest among working-age survivors aged 18–64 years (OR 1.65, 95% CI 1.41–1.92). Hardship ranged from 11.0% among prostate cancer survivors to 22.7% among lung cancer survivors. Non-Hispanic Black survivors had the largest absolute burden gap (+7.0 percentage points). Hardship was highest in the South (15.5% vs. 12.1%–13.7% elsewhere), but the regional association was attenuated after adjustment (OR 1.08, 95% CI 0.94–1.24). A combined targeting strategy focused on poor/near-poor, uninsured, and high-burden cancer-site survivors identified 53.1% of hardship cases while screening 32.6% of survivors, improving case-finding efficiency by 64% versus universal outreach (NNS 4.4 vs. 7.2). Conclusions: Financial hardship remains common among U.S. cancer survivors and is concentrated within identifiable high-risk populations. Although hardship was highest among survivors in the South, regional differences were largely attenuated after adjustment for socioeconomic and clinical factors. A risk-based financial navigation approach can identify a majority of hardship cases while substantially reducing screening burden, providing a practical framework for more efficient deployment of supportive care resources. Risk-stratified financial navigation targeting framework (MEPS 2017–2023). Screening Strategy % of Survivors Screened % of Hardship Cases Captured NNS Universal Outreach 100 100 7.2 Poor/Near-Poor (POVCAT 1–2) 12.8 35.0 2.6 Uninsured 1.6 2.7 4.3 High-Burden Sites (lung/CRC/breast) 22.4 27.5 5.9 Combined Targeted Strategy 32.6 53.1 4.4 NNS = number needed to screen to identify one financial hardship case. Targeting criteria applied as union (any criterion met). POVCAT = poverty category; CRC = colorectal cancer.