Financial Toxicity Hits Nonwhite Cancer Patients Hardest

Liam Davenport

February 22, 2022

Financial toxicity due to cancer is significantly more common among nonwhite patients, a recent analysis of survey data suggests.

The study found that Black individuals, in particular, are more than 5 times as likely as their white peers to be denied insurance and almost 2.5 times as likely to report being hurt financially because of their cancer care.

"Our data suggest that race is significantly associated with [financial toxicity] because of cancer," write the study's corresponding author Hanan Goldberg, MD, MSc, Urology Department, Upstate University Hospital, Syracuse, New York, and colleagues. The results highlight the importance of "raising awareness among health care administrators and providers regarding the association between increased financial toxicity and race."

The research was published in the February 1 issue of the JCO Oncology Practice.

Previous data indicate that access to cancer care, including screening and treatment, "is not equally accessible to racial minority populations," but the prevalence and impact of financial barriers across different racial groups remain less clear.

To examine the relationship between race and financial toxicity, Goldberg and colleagues examined data from the US Health Information National Trends Survey in 2012, 2014, and 2017.

The team analyzed responses from 1328 patients who reported being diagnosed with any type of cancer at any point in their lifetimes. They focused on two questions: "Has cancer hurt you financially?" and "Have you been denied health insurance because of cancer?"

Of the 1328 individuals with a history of cancer, the majority (75.1%) were white, 10.5% were Black, 9.7% were Hispanic, and 4.7% were other (unspecified) races. Almost 60% of all participants were women. The mean age at cancer diagnosis was 54.7 years, and the average age at the time of the survey was 65.8 years.

The team found that patients from all racial minorities were significantly more likely to receive no treatment for their cancer — 17.8% for Hispanic respondents, 15.0% for Black participants, and 9.7% for other races compared to 6.0% for white patients (P < .001). White respondents also had significantly higher rates of surgery (77%) compared with Black (60%) and Hispanic respondents (55%) as well as other races (74.2%; P < .001 for all).

Interestingly, racial minorities, especially Black patients, were more likely to receive radiotherapy and chemotherapy than white patients. For Black respondents, 39.3% underwent radiotherapy and 31.4% had chemotherapy vs 24.7% and 20%, respectively, of white respondents. However, the authors point out, these treatments "are less likely to be performed with curative intent."

A multivariate analysis revealed that Black individuals were 5 times more likely to be denied insurance than white people (odds ratio [OR], 5.0) and to report being damaged financially due to their cancer care (OR, 2.45; P < .001 for both). Other racial minorities were significantly more likely to report being hurt financially by cancer compared with white respondents (OR, 2.42; P = .009), but not denied insurance.

Income and geography were also associated with challenges in affording cancer care. Patients living in the South, for instance, were almost 2 times more likely to experience financial difficulties than those living in the Northeast (OR, 1.86; P < .001). And respondents earning at least $100,000 annually were substantially less likely to report being denied health insurance than those earning $0 to $49,999 (OR, 0.115; P = .005) and to report being hurt financially (OR, 0.49; P = .02).

The team acknowledges that the study has several limitations, including recall bias on self-reported information, and a lack of clinical details on disease stage, grade, and diagnosis and on the treatments offered.

However, the "data strongly suggest that compared with whites, racial minorities are significantly more likely to report being hurt financially and be denied health insurance because of cancer or undergoing treatment for their cancer," the authors conclude.

And, the team stressed, the healthcare community should be having "discussions with patients to understand their concerns and limitations related to treatment-associated costs and financial strategic planning," which has become especially critical given the "plethora of new and expensive cancer treatments becoming available, rapidly rising incidence of cancer, and improved survivorship of patients."

No funding was declared. Goldberg reported a consulting or advisory role at Myovant Sciences, and several other coauthors reported financial disclosures.

JCO Oncol Pract. 2022;18:e271-e283. Abstract

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