Financial hardship among rural cancer survivors: An analysis of the Medical Expenditure Panel Survey

Odahowski, Cassie L.; Zahnd, Whitney E.; Zgodic, Anja; Edward, Jean; Hill, Lauren N.; Davis, Melinda M.; Perry, Cynthia K.; Shannon, Jackilen; Wheeler, Stephanie B.; Vanderpool, Robin C.; Eberth, Jan M.

doi:10.1016/j.ypmed.2019.105881

Cited by 22 publications

(22 citation statements)

References 27 publications

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“…It is plausible that financial resources may lessen the overall burden of cancer survivors, which could improve self-perceived healthrelated quality of life, psychological well-being, and physical function among cancer survivors. We believe the current study's findings add to a growing body of literature demonstrating that survivorship is associated with financial hardship (8,(13)(14)(15)(16)(17)(18)(19)(20)(21).…”

Section: Discussionsupporting

confidence: 58%

Association Between Household Income and Self-Perceived Health Status and Poor Mental and Physical Health Among Cancer Survivors

O'Connor

Chiang

2021

Front. Public Health

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Background: Health-related quality of life (HRQoL) is multidimensional and is composed of, at a minimum, self-perceived health status, physical functioning, and psychological well-being. HRQoL measures reflect the extent of disability and dysfunction associated with a chronic disease such as cancer. The objective of this study is to examine factors associated with HRQoL among cancer survivors.Methods: Data from the 2009 Behavioral Risk Factor Surveillance System survey was used to examine factors associated with HRQoL among participants who reported having ever been diagnosed with cancer. Four questions associated with HRQoL included self-perceived health status, number of bad physical health days, and number of bad mental health days per month. Least square regression and logistic regression models, adjusted for confounding variables, were used for an ordinal and dichotomous [5 (bad) vs. 1–4 (excellent, very good, good, fair)] scale of HRQoL, respectively.Results: Fifty nine thousand one hundred seventy three participants reported having ever been diagnosed with cancer. Adjusted mean self-perceived health status (5-point scale) among survivors of thyroid, colon, lung, cervical, breast, prostate, and ovarian cancer was 3.83 (0.05), 4.02 (0.04), 4.36 (0.06), 3.77 (0.03), 3.88 (0.03), 3.78 (0.04), and 3.96 (0.05), respectively. After adjusting for confounders, a positive dose-response effect was observed between income range and all three HRQoL measures across all seven cancer sites. Income was consistently and inversely associated with a higher chance for reporting poorer HRQoL [OR: 0.64, 95% CI: 0.57–0.71], [OR: 0.63, 95% CI: 0.48–0.82], [OR: 0.67, 95% CI: 0.56–0.80], [OR: 0.69, 95% CI: 0.56–0.86], [OR: 0.55, 95% CI: 0.49–0.62], [OR:0.55, 95% CI: 0.44–0.69], [OR: 0.75, 95% CI: 0.62–0.91] among those with thyroid, colon, lung, cervical, breast, prostate, and ovarian cancer, respectively.Discussion: This study found that income range was associated with HRQoL among cancer survivors. It is plausible that financial resources may lessen the overall burden of cancer survivors, which could improve health-related quality of life among cancer survivors.

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Section: Discussionsupporting

confidence: 58%

Association Between Household Income and Self-Perceived Health Status and Poor Mental and Physical Health Among Cancer Survivors

O'Connor

Chiang

2021

Front. Public Health

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“…51 Studies using nationally representative data found both higher and lower risk of financial hardship when comparing rural and urban cancer survivors. 52,53 As more attention is turned toward geography-related health care disparities, researchers must remember the vast heterogeneity of both urban and rural areas with respect to sociodemographics, economic structures, and availability of health care resources. 54,55 Because system-level interventions such as patient navigation have been shown to reduce survivor Medicare spending and hospitalizations, 56 future research should incorporate multiple dimensions of geography to identify the optimal intervention to decrease medication nonadherence, drive down costs, and decrease preventable health care utilization.…”

Section: Discussionmentioning

confidence: 99%

Cost-Related Medication Nonadherence and Patient Cost Responsibility for Rural and Urban Cancer Survivors

Williams

Davidoff

Halpern

et al. 2022

JCO Oncology Practice

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PURPOSE: The relationship between out-of-pocket spending and cost-related medication nonadherence among older rural- and urban-dwelling cancer survivors is not well understood. METHODS: This retrospective cohort study used the Surveillance, Epidemiology, and End Results Program, Medicare claims, and the Consumer Assessment of Healthcare Providers and Systems survey linked data resource linked data (2007-2015) to investigate the relationship between cancer survivors' cost responsibility in the year before and after report of delaying or not filling a prescription medication because of cost in the past 6 months (cost-related medication nonadherence). Secondary exposures and outcomes included Medicare spending and utilization. Generalized linear models assessed bidirectional relationships between cost-related medication nonadherence, spending, and utilization. Effects of residence were assessed via interaction terms. RESULTS: Of 6,591 older cancer survivors, 13% reported cost-related medication nonadherence. Survivors were a median 8 years (interquartile range, 4.5-12.5 years) from their cancer diagnosis, 15% were dually Medicare/Medicaid-eligible, and prostate (40%) and breast (32%) cancer survivors were most prevalent. With every $500 USD increase in patient cost responsibility, risk of cost-related medication nonadherence increased by 3% (risk ratio, 1.03; 95% CI, 1.02 to 1.04). After report of cost-related medication nonadherence, patient cost responsibility was 22% higher (95% CI, 1.11 to 1.32) compared with those not reporting nonadherence, amounting to $523 USD (95% CI, $430 USD to $630 USD). Medicare spending and utilization were also higher before and after report of cost-related nonadherence versus none. For survivors residing in rural (18%) and urban (82%) areas, residence did not modify adherence or cost outcomes. CONCLUSION: A bidirectional relationship exists between patient cost responsibility and cost-related medication nonadherence. Interventions reducing urban- and rural-dwelling survivor health care costs and cost-related adherence barriers are needed.

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“…In addition, rural cancer survivors had poorer mental health outcomes compared to urban cancer survivors [ 165 , 168 ]. Studies have shown that rural cancer survivors report higher likelihood of financial toxicity compared to their urban counterparts, but this association is attenuated upon adjustment for other factors [ 170 , 171 ]. Studies have also identified cancer survivorship disparities among racial/ethnic minorities.…”

Section: Rural and Racial/ethnic Disparities In Cancer Across The mentioning

confidence: 99%

The Intersection of Rural Residence and Minority Race/Ethnicity in Cancer Disparities in the United States

Zahnd

Murphy

Knoll

et al. 2021

IJERPH

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One in every twenty-five persons in America is a racial/ethnic minority who lives in a rural area. Our objective was to summarize how racism and, subsequently, the social determinants of health disproportionately affect rural racial/ethnic minority populations, provide a review of the cancer disparities experienced by rural racial/ethnic minority groups, and recommend policy, research, and intervention approaches to reduce these disparities. We found that rural Black and American Indian/Alaska Native populations experience greater poverty and lack of access to care, which expose them to greater risk of developing cancer and experiencing poorer cancer outcomes in treatment and ultimately survival. There is a critical need for additional research to understand the disparities experienced by all rural racial/ethnic minority populations. We propose that policies aim to increase access to care and healthcare resources for these communities. Further, that observational and interventional research should more effectively address the intersections of rurality and race/ethnicity through reduced structural and interpersonal biases in cancer care, increased data access, more research on newer cancer screening and treatment modalities, and continued intervention and implementation research to understand how evidence-based practices can most effectively reduce disparities among these populations.

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Financial hardship among rural cancer survivors: An analysis of the Medical Expenditure Panel Survey

Cited by 22 publications

References 27 publications

Association Between Household Income and Self-Perceived Health Status and Poor Mental and Physical Health Among Cancer Survivors

Association Between Household Income and Self-Perceived Health Status and Poor Mental and Physical Health Among Cancer Survivors

Cost-Related Medication Nonadherence and Patient Cost Responsibility for Rural and Urban Cancer Survivors

The Intersection of Rural Residence and Minority Race/Ethnicity in Cancer Disparities in the United States

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