Background: Financial hardship is common among cancer survivors and is associated with both limiting care due to cost and with poor health-related quality of life (HRQOL). This study estimates the association between limiting care due to cost and HRQOL in a diverse population of cancer survivors and tests whether limiting care mediates the association between financial hardship and HRQOL.Methods: We used data from 988 participants (579 African American, 409 white) in the Detroit Research on Cancer Survivors (ROCS) pilot, a hospital-based cohort of breast, colorectal, lung, and prostate cancer survivors. We assessed associations between financial hardship, limiting care, and HRQOL [measured by the Functional Assessment of Cancer Therapy-General (FACT-G)] using linear regression and mediation analysis controlling for demographic, socioeconomic, and cancer-related variables.Results: FACT-G scores were 4.2 [95% confidence interval (CI), 2.0-6.4] points lower among survivors who reported financial hardship compared with those who did not in adjusted models. Limiting care due to cost was associated with a À7.8 (95% CI, À5.1 to À10.5) point difference in FACT-G scores. Limiting care due to cost explained 40.5% (95% CI, 25.5%-92.7%) of the association between financial hardship and HRQOL overall, and 50.5% (95% CI, 29.1%-188.1%) of the association for African American survivors.Conclusions: Financial hardship and limiting care due to cost are both associated with lower HRQOL among diverse cancer survivors, and this association is partially explained by limiting care due to cost.Impact: Actions to ensure patients with cancer can access appropriate care could lessen the impact of financial hardship on HRQOL.

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 hospitalbased 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.

Background: While the primary role of central cancer registries in the United States is to provide vital information needed for cancer surveillance and control, these registries can also be leveraged for population-based epidemiologic studies of cancer survivors. This study was undertaken to assess the feasibility of using the NCI's Surveillance, Epidemiology, and End Results (SEER) Program registries to rapidly identify, recruit, and enroll individuals for survivor research studies and to assess their willingness to engage in a variety of research activities.Methods: In 2016 and 2017, six SEER registries recruited both recently diagnosed and longer-term survivors with early age-onset multiple myeloma or colorectal, breast, prostate, or ovarian cancer. Potential participants were asked to complete a survey, providing data on demographics, health, and their willingness to participate in various aspects of research studies.Results: Response rates across the registries ranged from 24.9% to 46.9%, with sample sizes of 115 to 239 enrolled by each registry over a 12-to 18-month period. Among the 992 total respondents, 90% answered that they would be willing to fill out a survey for a future research study, 91% reported that they would donate a biospecimen of some type, and approximately 82% reported that they would consent to have their medical records accessed for research.Conclusions: This study demonstrated the feasibility of leveraging SEER registries to recruit a geographically and racially diverse group of cancer survivors.Impact: Central cancer registries are a source of high-quality data that can be utilized to conduct population-based cancer survivor studies.

Background: Financial hardship (FH) is common among cancer survivors and prevalence is often higher in non-white survivors. It is not known whether specific forms of FH are stronger predictors of financial distress than others, or if predictors of distress differ by race. Methods: We utilized data from 500 (196 white, 304 African American) participants in the Detroit Research on Cancer Survivors pilot cohort. Adults ages 20-79 were eligible if they were diagnosed with a first primary breast, colorectal, lung, or prostate cancer since January 1, 2013; identified through the Metropolitan Detroit Cancer Surveillance System; and diagnosed/treated at the Karmanos Cancer Institute. Measures of financial hardship included decreased income, cancer-related debt, utilizing assets or borrowing money to pay for cancer care, refusing treatment or not seeing a doctor when needed due to cost, and skipping doses of prescribed medication to save money. Financial distress was measured using the validated Comprehensive Score for Financial Toxicity (COST), coded so that lower scores indicate higher distress (lower financial quality of life). We used backward selection models including demographic and socioeconomic factors to identify predictors of financial distress overall and separately for white and African American survivors. Results: COST scores were 27.3 on average (SD: 10.9; 95% CI: 26.2, 28.3; range: 0-44), and were lower (more financial distress) in African American (24.5, 95% CI: 23.1, 25.8) than white survivors (31.0, 95% CI: 29.4, 32.5; p&lt;0.001). Younger age, being unmarried, lower income, not being employed, and having Medicaid coverage were all associated with higher financial distress. Debt, decreased income, utilizing assets, skipping doses of prescribed medication, and needing a doctor but not going were each independently associated with more financial distress overall (all p=0.013). Debt was associated with distress among both white and African American survivors in race-specific models (p=0.005) and decreased income was associated with distress in white (p=0.013) and marginally associated (p=0.06) in African American survivors. Not going to the doctor when needed and utilizing assets (both p&lt;0.001) predicted distress among white survivors, while refusing treatment due to cost (p=0.007) and skipping doses of prescribed medication to save money (p=0.007) predicted distress in African American survivors. Not going to a doctor when needed was more common in African American survivors, but more strongly associated with distress in white survivors (p-interaction=0.024). A similar pattern was observed for utilizing assets but was only marginally significant (p=0.08). Conclusions: Several forms of financial hardship were strongly associated with financial distress after cancer, but their association with distress differed by race. Some forms of financial hardship that are more common in African American survivors are more strongly associated with financial distress among white survivors. Citation Format: Theresa A. Hastert, Amanda R. Reed, Jennifer L. Beebe-Dimmer, Terrance L. Albrecht, Julia Mantey, Tara Baird, Ann G. Schwartz. Which forms of financial hardship predict financial distress among African American and white cancer survivors? [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr B032.