African American cancer survivors are more likely than whites to experience lasting debt or forgo necessary medical care as they struggle with the financial burden of cancer, whereas white cancer survivors are somewhat more likely to use existing assets to pay for their cancer care, according to a study released at the 9th American Association for Cancer Research (AACR) Conference on The Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved, held September 25–28 in Fort Lauderdale.

Theresa A. Hastert, PhD, MPP

“More than 1.6 million adults are diagnosed with cancer in the United States each year, and many face some form of financial hardship related to cancer and cancer treatment, even when they’re insured,” said the study’s lead author, ­Theresa A. Hastert, PhD, MPP, Assistant Professor in the Department of Oncology at Wayne State University School of Medicine and the Barbara Ann Karmanos Cancer Institute in Detroit. “In order to pay for cancer care, many patients experience changes to their financial situation that can include everything from cutting back on leisure spending to dipping into savings or selling assets, taking on debt, or even losing a home or declaring bankruptcy,” Dr. Hastert added.

Methodology

In order to analyze these measures of financial burden and to examine their effect on different racial groups, Dr. Hastert and colleagues used preliminary data from the Cancer Survivorship in Metropolitan Detroit cohort, focusing on African American and white adults aged 20 to 79 who had been diagnosed with a first primary breast, colorectal, lung, or prostate cancer some time since January 1, 2013.

The researchers targeted 1,000 survivors, all of whom had been diagnosed and/or treated at the Karmanos Cancer Institute. Participants completed a baseline questionnaire online or over the phone, which included demographic and socioeconomic questions in addition to questions designed to measure the financial impact of cancer.

Key Findings

Data collected from 695 participants so far (281 white, 414 African American) showed that 52.4% of all cancer survivors experienced some form of financial burden related to cancer, including 56.6% of African Americans and 46.3% of whites.

The study also showed that 31.2% of African American cancer survivors were in debt due to expenses related to their treatment, compared with 18.1% of white survivors.

African Americans were also more likely to have limited medical care, either by avoiding visiting a doctor when they may have needed to or skipping doses of prescribed medication due to cost concerns—21.3% of African-Americans compared with 14.6% of whites said they had made such choices.

The study showed that slightly more white survivors than African American survivors (24.7% compared with 19.2%) had used existing assets, such as savings or retirement accounts, to pay for cancer care.

Dr. Hastert said differences in net worth, ownership of financial assets, employment status, and the quality of insurance all may contribute to the larger financial burden on African American survivors.

“Being African American does not ‘cause’ the observed differences in financial hardship, but being black in the United States is associated with several conditions that all contribute to differences in socioeconomic status and to differences in the types of financial hardship experienced as a result of cancer, in the existence of lasting debt, and to not accessing necessary care because of cost,” she said.

Dr. Hastert added that this study, along with other research on the economic consequences of cancer survivorship, could contribute to interventions designed to reduce the financial burden of cancer. She noted that the study is still preliminary, with further responses pending, and that the study did not adjust for all measures of socioeconomic status. ■

Reference

1. Hastert TA, et al: How does the financial impact of cancer differ by race? 9th American Association for Cancer Research Conference on The Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved. Presented September 27, 2016.