Theresa A Hastert1,2, Matthew P Banegas3, Lauren M Hamel4,5, Amanda R Reed4,5, Tara Baird4,5, Jennifer L Beebe-Dimmer4,5, Ann G Schwartz4,5. 1. Department of Oncology, Wayne State University School of Medicine, Detroit, MI, USA. hastertt@karmanos.org. 2. Population Studies and Disparities Research Program, Karmanos Cancer Institute, Detroit, MI, USA. hastertt@karmanos.org. 3. Kaiser Permanente Center for Health Research, Portland, OR, USA. 4. Department of Oncology, Wayne State University School of Medicine, Detroit, MI, USA. 5. Population Studies and Disparities Research Program, Karmanos Cancer Institute, Detroit, MI, USA.
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.
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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