Association of Race With Cancer-Related Financial Toxicity

Abstract

PURPOSE: We investigated the association between race and FT among previous patients with cancer. Studies show that patients with cancer experience financial toxicity (FT) because of their cancer treatment. METHODS: Data on individuals with a cancer history were collected in this cross-sectional study during 2012, 2014, and 2017, from the US Health Information National Trends Survey. This survey is conducted by mail with monetary compensation as an incentive. We specifically assessed responses to two questions: Has cancer hurt you financially? Have you been denied health insurance because of cancer? Multivariable logistic regression analyses were used to assess the associations between these questions and race. RESULTS: Of 10,592 individuals participating, 1,328 men and women (12.5%) with a cancer history were assessed. Compared with Blacks, Whites were found to have a higher rate of insurance (95.4% v 90.0%), were more likely to receive cancer treatment (93.9% v 85%), and had a higher rate of surgical treatment than Blacks (77% v 60%), Hispanics (55%), and others (77%, 60%, 55%, and 74.2%, respectively, P < .001). On multivariable analysis, Blacks were more than five times as likely to be denied insurance (odds ratio, 5.003; 95% CI, 2.451 to 10.213; P < .001) and more than twice as likely to report being hurt financially because of cancer (odds ratio, 2.448; 95% CI, 1.520 to 3.941; P < .001) than Whites. Of all cancer groups analyzed (genitourinary, gynecologic, gastrointestinal, and breast), genitourinary malignancies were the only group in which the rate of reporting being hurt financially varied in a statistically significant manner (Whites 36.7%, Hispanics 62.5%, and Blacks 59.3%, P = .004). CONCLUSION: Our data suggest that race is significantly associated with FT because of cancer. Awareness of racial inequality with regards to FT should be raised among health care workers.

Insurance-based disparities and risk of financial toxicity among patients undergoing gynecologic cancer operations

“…The reasons for these disparities are likely multifactorial. Black and Hispanic patients often lack access to high-quality hospitals, present with more advanced stages of cancer, and experience more complications, thus incurring greater costs [34,35]. The reduced ability to access minimally invasive operations among those of minority race may be a compounding factor that further increases risk of FT, as open hysterectomy has been associated with increased costs [36].…”

Navigating financial toxicity in patients with cancer: A multidisciplinary management approach

“…FT is most common among individuals who are socioeconomically vulnerable because of lower income as well as inadequate health insurance 14,16‐21 . FT affects people who are racial and ethnic minorities more frequently than people who are non‐Hispanic White, likely reflecting their greater socioeconomic vulnerability in the United States 22,23 . An analysis of 2010 National Health Interview Survey data identified that, among respondents with a history of cancer, significantly more non‐Hispanic Black and Hispanic respondents (47% and 42%, respectively) reported a negative financial impact from cancer compared with 33% of non‐Hispanic White respondents 11 .…”

“…An analysis of 2010 National Health Interview Survey data identified that, among respondents with a history of cancer, significantly more non‐Hispanic Black and Hispanic respondents (47% and 42%, respectively) reported a negative financial impact from cancer compared with 33% of non‐Hispanic White respondents 11 . These racial and ethnic disparities in FT, as well as rural‐urban disparities, persist in contemporary data 22,24,25 . Younger age at cancer diagnosis is also associated with more persistent and severe FT 26 .…”

“…14,[16][17][18][19][20][21] FT affects people who are racial and ethnic minorities more frequently than people who are non-Hispanic White, likely reflecting their greater socioeconomic vulnerability in the United States. 22,23 An analysis of 2010 National Health Interview Survey data identified that, among respondents with a history of cancer, significantly more non-Hispanic Black and Hispanic respondents (47% and 42%, respectively) reported a negative financial impact from cancer compared with 33% of non-Hispanic White respondents. 11 These racial and ethnic disparities in FT, as well as rural-urban disparities, persist in contemporary data.…”

“…11 These racial and ethnic disparities in FT, as well as rural-urban disparities, persist in contemporary data. 22,24,25 Younger age at cancer diagnosis is also associated with more persistent and severe FT. 26 In survivors of cancer from the 2011 US Medical Expenditure Panel Survey Experiences With Cancer questionnaire, the relative frequency of material and psychological financial hardship in respondents aged 18 to 64 years was approximately 2 times higher than the frequency in those aged 65 years and older. 18 A recent survey conducted during the COVID-19 pandemic among adolescent and young adult (AYA) survivors who were treated for cancer before age 40 years at a mean interval of 8 years from diagnosis identified severe FT in one-half of all respondents.…”