Worry About Daily Financial Needs and Food Insecurity Among Cancer Survivors in the United States

Abstract

Background: A cancer diagnosis can impose substantial medical financial burden on individuals and may limit their ability to work. However, less is known about worry for nonmedical financial needs and food insecurity among cancer survivors. Methods: The National Health Interview Survey (2013–2017) was used to identify cancer survivors (age 18–39 years, n=771; age 40–64 years, n=4,269; age ≥65 years, n=7,101) and individuals without a cancer history (age 18–39 years, n=53,262; age 40–64 years, n=60,141; age ≥65 years, n=30,261). For both cancer survivors and the noncancer group, adjusted proportions were generated for (1) financial worry (“very/moderately/not worried”) about retirement, standard of living, monthly bills, and housing costs; and (2) food insecurity (“often/sometimes/not true”) regarding whether food would run out, the fact that food bought did not last, and the inability to afford balanced meals. Further adjusted analyses examined intensity measures (“severe/moderate/minor or none”) of financial worry and food insecurity among cancer survivors only. Results: Compared with individuals without a cancer history, cancer survivors aged 18 to 39 years reported consistently higher “very worried” levels regarding retirement (25.5% vs 16.9%; P<.001), standard of living (20.4% vs 12.9%; P<.001), monthly bills (14.9% vs 10.3%; P=.002), and housing costs (13.6% vs 8.9%; P=.001); and higher “often true” levels regarding worry about food running out (7.9% vs 4.6%; P=.004), food not lasting (7.6% vs 3.3%; P=.003), and being unable to afford balanced meals (6.3% vs 3.4%; P=.007). Findings were not as consistent for cancer survivors aged 40 to 64 years. In contrast, results were generally similar for adults aged ≥65 years with/without a cancer history. Among cancer survivors, 57.6% (age 18–39 years; P<.001), 51.9% (age 40–64 years; P<.001), and 23.8% (age ≥65 years; referent) reported severe/moderate financial worry intensity, and 27.0% (age 18–39 years; P<.001), 14.8% (age 40–64 years; P<.001), and 6.3% (age ≥65 years; referent) experienced severe/moderate food insecurity intensity. Lower income and higher comorbidities were generally associated with greater intensities of financial worry and food insecurity in all 3 age groups. Conclusions: Younger cancer survivors experience greater financial worry and food insecurity. In addition to coping with medical costs, cancer survivors with low income and multiple comorbidities struggle to pay for daily living needs, such as food, housing, and monthly bills.

The cost of cure: Examining objective and subjective financial toxicity in head and neck cancer survivors

“…It is well documented that medically-related financial toxicity is influenced by non-healthcare-related factors. Considerations such as food insecurity, 54 nonmedical costs of seeking care, 55,56 and loss of employment have been studied 57 but require more in-depth analysis within the HNC survivor population. Survey data were supplemented by HNC-specific OOPE data extracted via insurance claims for individuals who received care through the insuring institution.…”

Potential impact of the COVID‐19 pandemic on financial toxicity in cancer survivors

“…One study found a link between the 2008 economic recession and a decreased rate of cancer treatment, 55 implying that during economic hardships, patients may be less likely to seek cancer care due to financial constraints. Moreover, attainment of basic necessities may be disproportionately affected in cancer survivors who have reported greater levels of food insecurity (worrying about whether food would run out, food spoiling, and the inability to afford balanced meals) compared to individuals without a cancer history 56 . These coping strategies may be amplified during the COVID‐19 pandemic with the potential for devastating consequences on health and health outcomes, including cancer progression and death.…”

Impact of cancer on school, work, and financial independence among adolescents and young adults

“…12 Younger cancer survivors also experience greater financial worry and food insecurity and sometimes struggle to pay for daily living needs. 13 These financial stressors can lead to prolonged dependence on parents. 14 For example, an AYA patient in one study commented, "I still feel dependent on [my parents], because I live with them.…”