Race, financial hardship, and limiting care due to cost in a diverse cohort of cancer survivors

PurposeEstimate prevalence of types of cancer-related financial hardship by race and test whether they are associated with limiting care due to cost.MethodsWe used data from 994 participants (411 white, 583 African American) in a hospital-based 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.ResultsMore 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.ConclusionsThe prevalence of some forms of financial hardship differed by race, and these were differentially associated with limiting care due to cost.Implications for Cancer SurvivorsThe ability to use assets to pay for cancer care may protect survivors from limiting care due to cost. This has differential impacts on white and African American survivors.