Inequality in income change among cancer survivors five years after diagnosis: Evidence from a French national survey

• Published in: PloS one Vol. 14; no. 10; p. e0222832
• Main Authors: Alleaume, Caroline, Bendiane, Marc-Karim, Peretti-Watel, Patrick, Bouhnik, Anne-Déborah
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 03.10.2019; Public Library of Science (PLoS)
• Subjects: Accounting; Adult; Breast cancer; Cancer; Cancer diagnosis; Cancer patients; Cancer research; Cancer survivors; Cancer Survivors - statistics & numerical data; Cancer treatment; Care and treatment; Costs; Demographics; Diagnosis; Economics; Equality; Family Characteristics; Fees; Female; France - epidemiology; Health insurance; Humans; Income; Income - statistics & numerical data; Income distribution; Inequalities; Insurance; Internet; Legal fees; Life Sciences; Living conditions; Male; Medical diagnosis; Medicine and Health Sciences; Middle Aged; Missing data; National health insurance; Neoplasms - diagnosis; Neoplasms - epidemiology; People and places; Personal income; Polls & surveys; Population; Quality of life; Santé publique et épidémiologie; Self employment; Social aspects; Social class; Social Sciences; Socioeconomic Factors; Socioeconomics; Studies; Surveys; Surveys and Questionnaires; Survival; Tumors; Well being; France
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0222832

Worldwide, around 18 million people receive a cancer diagnosis each year, most of whom survive long enough to face additional cancer-related costs. In France, most costs directly related to cancer are covered by the National Health Insurance Fund, and cancer patients can receive treatments without paying advance fees. In this context, the costs faced by cancer survivors are mostly social costs. Drawing on fundamental cause theory, this study aimed to explore the socially-differentiated evolution of cancer survivor's income five years after diagnosis. Our study draws on the findings of VICAN5, a French national survey that was conducted in 2015/2016 in a representative sample of 4,174 cancer survivors to obtain information on living conditions five years after diagnosis, and that was restricted to 12 tumour sites accounting for 88% of global cancer incidence in France. We used the multiple imputation method and the Heckman selection model to identify the factors associated with a decrease in household income per consumption unit (HICU), while accounting for missing data. Among survivors still working five years after diagnosis, 17.6% reported lower income at survey than at diagnosis. After adjustment for socio-demographic and medical characteristics, the decrease in HICU was more frequent in women, singles, low educated survivors, and survivors with reduced working time. Finally, subjective measures of income variation and economic well-being were a useful complement to objective measures since 31.6% of cancer survivors still working five years after diagnosis reported a perceived decrease in household income. In conclusion, inequalities in economic well-being persist long after diagnosis in France, and this despite the fact that most cancer-related costs are covered by the French National Health Insurance Fund. Consequently, more attention should be paid to cancer patients with low socio-economic status to help reduce inequalities in post-diagnosis living conditions.