Rural-urban differences in financial burden among cancer survivors: an analysis of a nationally representative survey

Zahnd, Whitney E.; Davis, Melinda M.; Rotter, Jason; Vanderpool, Robin C.; Perry, Cynthia K.; Shannon, Jackilen; Ko, Linda K.; Wheeler, Stephanie B.; Odahowski, Cassie L.; Farris, Paige E.; Eberth, Jan M.

doi:10.1007/s00520-019-04742-z

Cited by 70 publications

(58 citation statements)

References 28 publications

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“…Among our sample of Appalachian Kentucky cancer survivors, almost two‐thirds indicated some level of cancer‐related financial distress, which is notably higher than estimates provided by HINTS and other national health surveys and likely driven by the socioeconomic characteristics of extremely rural Appalachian communities. These findings warrant further research, including qualitative assessments with Appalachian cancer survivors, family members, and oncology providers and support staff.…”

Section: Discussioncontrasting

confidence: 59%

“…Understanding financial distress among special populations of cancer survivors is important especially given the disparities of those residing in rural areas of the U.S . Compared to urban locales, rural communities commonly experience higher rates of cancer incidence and mortality, disparate socioeconomic and education outcomes, health insurance challenges, geographic isolation, transportation barriers, and difficulties accessing oncology and social services, among other issues, which may further exacerbate the financial hardship of being diagnosed with cancer . For example, McDougall et al found that rural colorectal cancer survivors in New Mexico were twice as likely as urban survivors to report treatment‐related financial hardship .…”

Section: Introductionmentioning

confidence: 99%

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Financial distress among cancer survivors in Appalachian Kentucky

et al. 2019

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Background: Rural residence may exacerbate cancer-related financial distress.Limited research has focused on Appalachian cancer survivors' experience with financial distress. Aims:The primary aim of this study was to estimate the prevalence of financial distress among cancer survivors residing in Appalachian Kentucky with a specific focus on the impact of rurality and to elucidate the risk factors impacting financial distress among this population. Methods and Results: Appalachian Kentucky residents were sampled for receipt of a health survey based on county-level rurality. Analyses describe the prevalence and predictors of financial distress among cancer survivors. Subsequent analyses were conducted with Health Information National Trends Survey (HINTS) data to compare local versus national estimates of financial distress. Almost two-thirds of Appalachian survivors reported financial distress compared to one-third of the HINTS sample.Appalachian survivors residing in the most rural counties reported higher distress; this finding was not supported in the national sample. In multivariable analyses, gender, current age, and household income were associated with financial distress among Appalachians; only income was significant among the national sample.Conclusion: Appalachian cancer survivors have higher than national estimates of financial distress; rurality and socioeconomics are drivers of this disparity. K E Y W O R D SAppalachian region, financial distress, neoplasms, rural health, surveys and questionnaires, survivorship

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Section: Discussioncontrasting

confidence: 59%

Section: Introductionmentioning

confidence: 99%

Financial distress among cancer survivors in Appalachian Kentucky

et al. 2019

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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

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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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“…Despite the aforementioned limitations, our study is an important contribution to the growing body of literature regarding cancer-related financial hardship among rural cancer survivors (McDougall et al 2018; Palmer et al 2013; Pisu et al 2017; Zahnd et al 2019). To our knowledge, the present study is the first to examine the relationship between cancer-related debt and MHQOL among rural cancer survivors and to assess how family/friend informal caregiver networks moderate this relationship.…”

Section: Discussionmentioning

confidence: 99%

“…Cancer-related financial hardship, including cancer-related debt, represents a major, modifiable, and increasingly studied stressor that negatively affects the QOL of cancer survivors (Ell et al 2008; Fenn et al 2014; Hastert et al 2019; Kale and Carroll 2016; Meneses et al 2012). Despite the growing body of work demonstrating a relationship between cancer-related financial hardship and cancer survivors’ QOL, relatively little work has assessed the extent or impact of this stressor for rural cancer survivors (McDougall et al 2018; Palmer et al 2013; Pisu et al 2017; Zahnd et al 2019). This is surprising given that rural populations often are more socioeconomically disadvantaged relative to urban populations in terms of individual and contextual factors, including individual and household income, job and wage growth, and for some regions, poverty rate (Bishaw and Posey 2016; Cromartie 2017).…”

Section: Introductionmentioning

confidence: 99%

Cancer-Related Debt and Mental-Health-Related Quality of Life among Rural Cancer Survivors: Do Family/Friend Informal Caregiver Networks Moderate the Relationship?

et al. 2020

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Social connectedness generally buffers the effects of stressors on quality of life. Is this the case for cancer-related debt among rural cancer survivors? Drawing on a sample of 135 rural cancer survivors, we leverage family/friend informal caregiver network data to determine if informal cancer caregivers buffer or exacerbate the effect of cancer-related debt on mental-health-related quality of life (MHQOL). Using data from the Illinois Rural Cancer Assessment, a survey of cancer survivors in rural Illinois, we estimate the association between cancer-related debt and MHQOL and whether informal caregiver network size and characteristics moderate this association. Over a quarter of survivors (27%) reported cancer-related debt, and those who did reported worse MHQOL. However, this association only held for survivors who had an informal caregiver network. These findings supplement what is already known about the role of social connectedness in cancer survivors’ health outcomes. We offer possible explanations for these findings.

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Rural-urban differences in financial burden among cancer survivors: an analysis of a nationally representative survey

Cited by 70 publications

References 28 publications

Financial distress among cancer survivors in Appalachian Kentucky

Financial distress among cancer survivors in Appalachian Kentucky

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

Cancer-Related Debt and Mental-Health-Related Quality of Life among Rural Cancer Survivors: Do Family/Friend Informal Caregiver Networks Moderate the Relationship?

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