Support Care Cancer. 2025 Sep 1;33(9):828. doi: 10.1007/s00520-025-09881-0.
ABSTRACT
PURPOSE: The impact of a cancer diagnosis on racial differences in financial well-being and treatment related financial toxicity has not been well characterized. The purpose of this study was to compare relative disparities in financial distress by race among respondents with and without a history of cancer.
METHODS: We performed a retrospective cohort study based on the National Health Interview Survey (2010 to 2018). Primary outcomes included financial hardship questions about medication adherence, worry about medical costs, and worry about monthly bills. Multivariable logistic regression analysis examined the association of a cancer diagnosis and racial disparities in financial hardship using an interaction term of race and history of cancer.
RESULTS: We included 204,754 participants without a history of cancer and 19,094 cancer survivors. Black participants with a history of cancer reported higher rates of medication modification due to financial constraints (9.2%), compared to Black participants without cancer (4.8%) and White participants with (5.1%) or without (3.8%) cancer. By multivariable analysis, a history of cancer significantly worsened Black-White disparities in financial-related medication adherence measures and problems with medical bills, with Black patients more likely to report that they took less medicine to save money (OR 1.48, 95% CI 1.17-1.88, P = 0.001), delayed filling prescriptions to save money (OR 1.42, 95% CI 1.13-1.77, P = 0.002), and asked for lower-cost medications to save money (OR 1.27, 95% CI 1.07-1.50, P = 0.005), had problems paying medical bills (OR 1.29, 95% CI 1.08-1.53, P = 0.003), paid off medical bills over time (OR 1.45, 95% CI 1.24-1.69, P < 0.001), and delayed medical care because of worry about cost (OR 1.31, 95% CI 1.03-1.66, P = 0.023).
CONCLUSIONS: Black-White disparities in self-reported medical financial hardship among insured adults are worsened by a diagnosis of cancer. Policy- and system-level interventions are required to improve long-term financial distress among Black cancer survivors.
PMID:40888994 | DOI:10.1007/s00520-025-09881-0
