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Race, financial hardship, and limiting care due to cost in a diverse cohort of cancer survivors

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Journal of Cancer Survivorship Aims and scope Submit manuscript

Abstract

Purpose

Estimate prevalence of types of cancer-related financial hardship by race and test whether they are associated with limiting care due to cost.

Methods

We used data from 994 participants (411 white, 583 African American) in a hospital-based cohort study of survivors diagnosed with breast, colorectal, lung, or prostate cancer since January 1, 2013. Financial hardship included decreased income, borrowing money, cancer-related debt, and accessing assets to pay for cancer care. Limiting care included skipping doses of prescribed medication, refusing treatment, or not seeing a doctor when needed due to cost. Logistic regression models controlled for sociodemographic factors.

Results

More African American than white survivors reported financial hardship (50.3% vs. 41.0%, p = 0.005) and limiting care (20.0% vs. 14.2%, p = 0.019). More white than African American survivors reported utilizing assets (9.3% vs. 4.8%, p = 0.006), while more African American survivors reported cancer-related debt (30.5% vs. 18.5%, p < 0.001). Survivors who experienced financial hardship were 4.4 (95% CI: 2.9, 6.6) times as likely to limit care as those who did not. Borrowing money, cancer-related debt, and decreased income were each independently associated with limiting care, while accessing assets was not.

Conclusions

The prevalence of some forms of financial hardship differed by race, and these were differentially associated with limiting care due to cost.

Implications for Cancer Survivors

The ability to use assets to pay for cancer care may protect survivors from limiting care due to cost. This has differential impacts on white and African American survivors.

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Funding

This research was funded by the American Cancer Society (MRSG-17-019), NIH grants/contracts PC35145 and HHSN261261201300011I, and by the Karmanos Cancer Institute and the General Motors Foundation.

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Authors and Affiliations

  1. Department of Oncology, Wayne State University School of Medicine, Detroit, MI, USA

    Theresa A. Hastert, Lauren M. Hamel, Amanda R. Reed, Tara Baird, Jennifer L. Beebe-Dimmer & Ann G. Schwartz

  2. Population Studies and Disparities Research Program, Karmanos Cancer Institute, Detroit, MI, USA

    Theresa A. Hastert, Lauren M. Hamel, Amanda R. Reed, Tara Baird, Jennifer L. Beebe-Dimmer & Ann G. Schwartz

  3. Kaiser Permanente Center for Health Research, Portland, OR, USA

    Matthew P. Banegas

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  1. Theresa A. Hastert
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  2. Matthew P. Banegas
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  4. Amanda R. Reed
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Corresponding author

Correspondence to Theresa A. Hastert.

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The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments.

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Informed consent was obtained from all individual participants included in this study.

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Hastert, T.A., Banegas, M.P., Hamel, L.M. et al. Race, financial hardship, and limiting care due to cost in a diverse cohort of cancer survivors. J Cancer Surviv 13, 429–437 (2019). https://doi.org/10.1007/s11764-019-00764-y

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  • DOI: https://doi.org/10.1007/s11764-019-00764-y

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