Financial Hardship and Quality of Life among African American and White Cancer Survivors: The Role of Limiting Care Due to Cost

Abstract

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.

Medical financial hardship reported by Native Hawaiian and Pacific Islander cancer survivors compared with non‐Hispanic whites

“…Altice et al conducted a systematic review of studies that described financial hardship experienced by cancer survivors and categorized existing measures into 3 categories: 1) material conditions (out‐of‐pocket costs, productivity loss, medical debt, or bankruptcy), 2) psychological responses (such as distress or worry from hardship), and 3) coping behaviors (skipped medications) . Among the studies they reviewed as well as other studies published after the review, most examined material conditions, and fewer examined coping behaviors or psychological responses. In our study, we used a measure of MFH that encompasses all 3 domains and has been used in previous studies among cancer survivors …”

“…Most studies only investigated this relation in the general cancer survivor population . Hastert et al reported differential forms of financial hardship experienced by African American versus white cancer survivors and found that it was associated with differences in limiting care because of cost . In 2018, McElfish et al examined the relation between financial hardship and health care‐seeking behaviors in NHPIs .…”

Work changes and individual, cancer‐related, and work‐related predictors of decreased work participation among African American cancer survivors

“…Such extended unpaid absences from work put survivors at risk of income loss and other financial hardships, which are associated with clinically significantly lower levels of health-related quality of life and, our results suggest, may be more common in African American survivors than among cancer survivors overall. 2 Work outcomes are often worse among African American than white survivors. 12,19,20,31,32 These differences may be due in part to differences in the types of jobs and their associated levels of compensation and employer-sponsored benefits provided.…”

“…Nearly half of cancer survivors report adverse financial outcomes or even "catastrophic" financial hardship related to cancer or cancer treatment. [1][2][3] Financial hardship due to cancer is associated with lower health-related quality of life (HRQOL), 2 lower treatment adherence, 3 and even with higher mortality. 4 Difficulty maintaining employment during and returning to employment after cancer treatment represents a potentially modifiable risk factor for financial hardship among cancer survivors.…”

“…African Americans are underrepresented in white collar and professional occupations 13, 14 that have the best job retention after cancer, and are overrepresented in positions requiring physically demanding work that is associated with reduced employment after cancer. [15][16][17][18][19] Decreased employment 12,19,20 and financial hardship 2,3,21 are more common among African American than white survivors.…”