Association of socioeconomic and practical unmet needs with self-reported nonadherence to cancer treatment appointments in low-income Latino and Black cancer patients

Abstract

Objective Treatment adherence, with minimal numbers of missed appointments, is an important determinant of survival among cancer patients. This study aims to determine if unmet financial, logistic and supportive care needs predict self-reported adherence to cancer treatment appointments of chemotherapy and/or radiation among low-income ethnic minority patients. Design The sample included 1098 underserved Latino and Black patients recruited from cancer clinics in New York City through the Cancer Portal Project (CPP). Participants completed a survey which included sociodemographic, health-related questions and a needs assessment, in their preferred language. Patients’ adherence to chemotherapy and/or radiation treatment appointments was assessed using a self-report. Results A sample of 1098 patients (581 Latino and 517 Black cancer patients) was recruited. Forty-two Latino cancer patients (7.4%) and seventy-eight Black cancer patients (15.5%) reported missing treatment appointments. Patients, who experienced four or more unmet needs (OR's=2.02-3.36), and those with unmet housing needs (OR's=3.10-3.31), were more likely to report missing cancer treatment appointments, regardless of their ethnicity/race. Black patients with unmet supportive care (OR=2.27) and health insurance needs (OR=3.80) were more likely to miss appointments. Amongst Latinos, legal health-related issues (OR=2.51) was a significant predictor of missed appointments. Conclusions Among ethnic minority cancer patients, unmet socioeconomic and supportive care needs, housing needs in particular, predicted patient-reported missed radiation and/or chemotherapy appointments. Future research should focus on exploring the impact of practical and supportive unmet needs on adherence and development of interventions aiming to improve cancer treatment adherence.

The Role of Demographics, Social Deprivation and Ethnicity on Anal Squamous Cell Carcinoma Incidence in England

“…The UK Government Indices of Deprivation produces a deprivation score based on income levels, education attainment, risk of crime, employment levels, barriers to housing and services, quality of living environment and the risk of poor health and quality of life [12]. Factors associated with low SES such as; difficulties accessing primary care, low education attainment inhibiting patient compliance or limiting patient understanding of cancer risk [28], unstable employment preventing attendance at clinical appointments [29] and volatile housing leading to delays in patients being contacted after abnormal test results all have the potential to limit access to healthcare for patients with a low SES. This dataset demonstrated that patients with a lower SES were more likely to present at a younger age with ASCC, Additionally, higher levels of social deprivation were associated with requiring all three treatment modalities (surgery, chemotherapy and radiotherapy) for Stage 3 patients in this dataset.…”

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

“…This is at least in part attributable to maladaptive coping strategies such as treatment nonadherence 51 . In attempts to remedy increasing costs, patients limit use of medications, miss clinical appointments, borrow money, take credit card loans or have family members work additional hours 51‐54 . 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.…”

Socio-economic patterning in early mortality of patients aged 0–49 years diagnosed with primary bone cancer in Great Britain, 1985–2008

“…A study from Brazil found that low educational level, but not low income, was associated with treatment compliance for chronic myeloid leukaemia [24]. A study from New York City found that housing needs amongst ethnic minorities was associated with lack of adherence to radiotherapy and chemotherapy [25]. However, access to health care in these three countries is markedly different from the UK, which has universal health insurance coverage.…”