The Relationship Between Cancer Survivors’ Socioeconomic Status and Reports of Follow-up Care Discussions with Providers

Abstract

Socioeconomically disadvantaged cancer survivors are less likely to have adequate follow-up care. In this study, we examined whether socioeconomically disadvantaged survivors are at risk for not having follow-up care discussions with providers, a critical determinant of access to follow-up care and desirable health outcomes. Using the 2011 Medical Expenditure Panel Survey and Experiences with Cancer Survivorship Supplement, we used a binary logit model with sample weights to examine associations between 1,320 cancer survivors’ socioeconomic status (SES) and reports of follow-up care discussions with providers, controlling for clinical and demographic characteristics. The multivariable model indicated survivors with incomes ≤200% Federal Poverty Level (FPL) had a lower probability of reporting a follow-up care discussion than survivors with incomes >400% FPL (p<.05). Survivors with <high school education had a lower probability of reporting a discussion than survivors who had a college education (p<.05). However, even after controlling for income, survivors with financial hardship had a greater probability of reporting a discussion than survivors with no financial hardship (p<.05). Insurance status was not a significant predictor of reporting a discussion (p>.05). Socioeconomically disadvantaged cancer survivors are at risk for not having follow-up care discussions with providers, particularly those who report lower income and education. Development of educational interventions targeting provider communication with socioeconomically disadvantaged cancer survivors, and survivors’ understanding of the benefits of follow-up care discussions, may promote access to these services. Future research assessing mechanisms underlying relationships between survivors’ SES indicators and reports of follow-up care discussions with providers is also warranted.

Symptom Clusters in Breast Cancer Survivors: A Latent Class Profile Analysis

“…One plausible explanation is that individuals with higher socioeconomic status, measured as higher education and employment, may be more likely to engage in healthy lifestyle behaviors (e.g., physical activity) (Naik et al, 2016;Park et al, 2015). Those with higher economic status also may be better able to access appropriate healthcare services and communicate with clinicians after treatment has ended, thereby facilitating better symptom management (DiMartino, Birken, & Mayer, 2017). Because of the cross-sectional approach in this study, it is difficult to determine whether employment status is truly protective against problematic co-occurring symptoms or whether individuals who experience worse symptoms are more likely to leave the workforce (Ellis, 2013;Seib et al, 2017;Shi et al, 2011).…”

Impact of cervical cancer on quality of life of women in Hubei, China

“…Reports indicate that less education had been associated with limited knowledge about health issues and poor health 10 , 21 . Cancer survivors living in the rural area are at higher risk for a variety of poor health outcomes 29 and poor socioeconomic status (e.g., lower education level and income) are less likely to have follow-up care with providers leading to poor health outcome 27 , 30 . Patients from a rural area or with lower economic status or illiterate people might be unaware of cervical cancer.…”

Financial Burdens of Cancer Treatment: A Systematic Review of Risk Factors and Outcomes

“…5,50,70 In the pooled analysis, patients with higher financial burdens (defined as having greater financial distress, copayments, or direct prescription costs) had nearly twice greater odds of cancer medication nonadherence (OR, 1.70; 95% CI, 1.13-2.56) ( Figure 4; sensitivity analyses in eAppendix 1). Higher financial burdens were also associated with general medical nonadherence in a limited number of studies, including higher frequency of omitted or delayed subsequent cancer screening in patients with cancer and survivors; forgoing or delaying cancer survivorship care and follow-up, dental care, ophthalmologic care, prescription medications, and mental and primary medical care 28,36,37,53,68,81,82 ; and lower health selfefficacy and treatment decision-making. 58 Financial burdens, specifically indirect burdens and psychological burdens, were associated with decreased health-related quality of life (HRQoL) dimensions across the studies (supplemental eTable 5), with more than twice the odds of worse overall physical, mental, emotional, and social function and well-being and increased anxiety, depression, and worry.…”