Medical financial hardship reported by Native Hawaiian and Pacific Islander cancer survivors compared with non‐Hispanic whites

Abstract

BACKGROUND: Although medical financial hardship (MFH) resulting from sequelae of cancer and treatment has been reported in other racial/ethnic populations, little is known about MFH among Native Hawaiian and Pacific Islander (NHPI) cancer survivors. METHODS: One hundred fifty adult NHPI cancer survivors were identified from the 2014 NHPI National Health Interview Survey (NHIS). Cancer survivors were those with a history of cancer (excluding nonmelanoma/unknown type of skin cancer). MFH was defined by 3 domains: 1) material (problem paying or unable to pay medical bills); 2) psychological (worrying about paying medical bills); and 3) behavioral (delaying or forgoing medical care for financial reasons). For comparison, 2098 non-Hispanic white (NHW) cancer survivors were identified from the 2014 NHIS. Logistic regressions were used to identify sociodemographic and health factors associated with experiencing MFH. Stratified analysis by age (<65 vs ≥65 years) and sensitivity analysis using propensity score-matched NHPI and NHW cancer survivors were conducted. Nationally representative estimates were generated using survey weights. RESULTS: Among elderly cancer survivors, more NHPIs reported any MFH (59% vs 32%; P = .001), psychological MFH (36% vs 22%; P = .040), and behavioral MFH (27% vs 9%; P = .004) than NHWs. Among survivors aged <65 years, NHPIs reported less MFH (46% vs. 65%; P = .034). Even after propensity score matching, these patterns persisted. Female NHPIs and NHPIs with a college degree were significantly more likely to report MFH, especially material and psychological MFH. CONCLUSIONS: A significantly higher proportion of elderly NHPI cancer survivors reported MFH, and this difference persisted even after propensity score matching, which warrants further investigation. Cancer 2020;126:2900-2914.

Navigating Native Hawaiian and Pacific Islander Cancer Disparities From a Cultural and Historical Perspective

“…13 Post-treatment, US NHPIs experience disproportionately high financial toxicity, causing major psychological harm. 14 PIs also have a unique cancer contextualization given nuclear bomb testing. During the Cold War, the United States detonated 67 hydrogen bombs on the Marshall Islands, with an aggregate explosion akin to 7,200 Hiroshima bombs.…”

Neighborhood Characteristics and Cancer Survivorship: An Overview of the Current Literature on Neighborhood Landscapes and Cancer Care

“…Among the scoped articles, survival disparities, primary care, environmental exposures, quality of life, and residential mobility were the main themes related to surveillance. Neighborhood measures utilized in these articles were: nSES, neighborhood ethnic enclaves [ 36 ], residential segregation [ 37 ], access and travel distance [ 38 ], pharmacy access [ 39 ], food access [ 18 ], social and economic polarization [ 40 ], neighborhood amenities [ 39 ], neighborhood tenure [ 41 ], perceived social cohesion [ 41 , 42 ], and social capital [ 43 ]. nSES was the most common metric and there is abundant literature that shows lower nSES exerts a deleterious effect on cancer outcomes which goes beyond the area supply of specific heath care types [ 44 ].…”

“…Across the scoped articles, social support, quality of life, self-rated health, medical and financial hardships, and stress management were the studied themes. Among these reviewed articles, nSES, neighborhood social support [ 22 ], neighborhood social cohesion [ 42 ], perceived neighborhood stress [ 69 ], and housing situation were the neighborhood-level variables under the psychological well-being theme. One study found a strong association between social support and financial circumstances and one or more unmet needs among head and neck cancer survivors [ 22 ].…”

Greater financial toxicity relates to greater distress and worse quality of life among breast and gynecologic cancer survivors

“…For example, Native Hawaiian and Pacific Islanders report greater financial hardship than other Asian subgroups (i.e., Asian Indian, Chinese, Filipino, and Other) and compared to non-Hispanic Whites. 34 Hispanic/Latina women with breast cancer are more likely to report job insecurity and feel cancer significantly impacted their employability than White, Asian, and Black women, whereas Black women are more likely to report economicrelated discrimination as a barrier to care. 35 Unfortunately, it appears that health disparities across races and ethnicities persist even at high income levels, 36,37 suggesting the importance of focusing on financial experiences and health disparities across race/ethnicity subgroups at all socioeconomic strata.…”

“…It is important to recognize the varying experiences between and within race and ethnicity subgroups. For example, Native Hawaiian and Pacific Islanders report greater financial hardship than other Asian subgroups (i.e., Asian Indian, Chinese, Filipino, and Other) and compared to non‐Hispanic Whites 34 . Hispanic/Latina women with breast cancer are more likely to report job insecurity and feel cancer significantly impacted their employability than White, Asian, and Black women, whereas Black women are more likely to report economic‐related discrimination as a barrier to care 35 .…”