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Financial burdens more common in black cancer survivors
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Black cancer survivors appeared more likely than white survivors to face lasting debt and limit their medical care due to cost concerns, according to study results presented at the AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved.
White survivors were more likely to use existing assets to pay for their cancer care, results showed.
“More than 1.6 million adults are diagnosed with cancer in the United States each year, and many face some form of financial hardship related to cancer and cancer treatment, even when they’re insured,” Theresa A. Hastert, PhD, MPP, assistant professor in the department of oncology at Wayne State University School of Medicine and the Barbara Ann Karmanos Cancer Institute in Detroit, said in a press release. “In order to pay for cancer care, many patients experience changes to their financial situation that can include everything from cutting back on leisure spending to dipping into savings or selling assets, taking on debt, or even losing a home or declaring bankruptcy.”
To analyze how the financial burden of cancer care differs by race, Hastert and colleagues evaluated data from 695 survivors (white, n = 281; black, n = 414) in the Cancer Survivorship in Metropolitan Detroit cohort. This cohort includes adults aged 20 to 79 years diagnosed with a first primary breast, colorectal, lung or prostate cancer after Jan. 1, 2013 who were treated at Karmanos Cancer Institute.
The survivors completed baseline questionnaires online or over the phone about their demographic and socioeconomic characteristics, medical history and financial burden measures, which included whether they sold assets or borrowed money to pay for cancer care, experienced limited care due to cost, had a decrease in income since diagnosis, or were in debt due to medical expenses.
Overall, 52.4% of all survivors experienced some form of financial burden.
A greater proportion of black survivors than white survivors experienced a financial burden (56.6% vs. 46.3%; P = .011). Conversely, a greater proportion of white survivors used existing assets to pay for their cancer care (24.7% vs. 19.2%), which included withdrawing money from savings (14.6% vs. 9.2%; P = .027) or retirement accounts (7.8% vs. 3.4%; P = .009) to pay for their care.
Debt due to medical expenses occurred more frequently in black survivors (31.2% vs. 18.1%; P < .001). More black survivors also reported that they limited their care due to cost concerns (21.3% vs. 14.6%; P = .027), which included not seeing a doctor they needed to (15.1% vs. 9.1%; P = .022) and skipping doses of prescribed medication (8.8% vs. 5.4%).
A comparable proportion of black and white survivors borrowed money from family or friends (9.8% for both), sold stocks or other investments (1.2% vs. 2.1%), refused treatment due to cost (4.6% vs. 5%) or experienced a decrease in income due since diagnosis (30.2% vs. 27.3%).
Results of adjusted analyses showed black race increased the likelihood for going into debt due to cancer (OR = 2.09; 95% CI, 1.39-2.14) and experiencing any type of financial burden (OR = 1.49; 95% CI, 1.04-2.12). Researchers also observed associations of borderline significance with black race and skipping doses of prescribed medicine (OR = 1.77; 95% CI, 0.92-3.42) and limiting care due to cost (OR = 1.46; 95% CI, 0.93-2.28).
The researchers acknowledged the study did not adjust for all factors of socioeconomic status.
“Being African-American does not ‘cause’ the observed differences in financial hardship, but being black in the United States is associated with several conditions that all contribute to differences in socioeconomic status and to differences in the types of financial hardship experienced as a result of cancer, in the existence of lasting debt, and to not accessing necessary care because of cost,” Hastert said. – by Alexandra Todak
Reference:
Hastert TA, et al. Abstract C13. Presented at: AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Sept. 25-28, 2016; Fort Lauderdale, Fla.
Disclosure: The study was funded by Karmanos Cancer Institute. Hastert reports no relevant financial disclosures.