“You Have to Keep a Roof Over Your Head”: A Qualitative Study of Housing Needs Among Patients With Cancer in New York City

Abstract

PURPOSE: Housing status can become compromised in the wake of financial hardship for some patients with cancer and become a source of disparity. This qualitative study describes the types of housing issues experienced by patients with cancer and survivors of cancer in New York City. METHODS: Semistructured interviews were conducted with a volunteer sample of 21 patients with cancer or survivors of cancer treated in New York City who reported housing needs in the period after diagnosis through survivorship. Nine supplemental interviews were conducted with cancer and housing key informants. Conventional content analysis was conducted on transcripts to create a codebook describing types of housing needs. RESULTS: Patients and survivors most commonly had breast (n = 9) and blood (n = 4) cancers and ranged from recently diagnosed to many years posttreatment. Twenty-nine distinct housing-related issues were identified, which were grouped into the following six major categories: housing costs (eg, rent, mortgage), home loss, doubled up or unstable housing, housing conditions, accessibility (eg, stairs, proximity to amenities), and safety. Issues were often interrelated. Housing needs sometimes predated cancer diagnosis. Other issues newly emerged in the wake of cancer-related physical limitations and disruption to finances. Needs ranged in severity and caused patients and survivors considerable burden during a difficult period of poor health and financial strain. CONCLUSION: This study contributes depth to current understandings of housing needs among patients with cancer and survivors by providing detailed disaggregated descriptions. We recommend increasing availability of services responsive to these needs and exploring promising options such as patient navigation and legal services. Findings also highlight the importance of creative solutions addressing ecologic-level factors such as housing affordability.

The association between housing and food insecurity among medically underserved cancer patients

“…Some of our participants were homeowners, and as household income is affected by cancer-related income and/or job loss, home maintenance, taxes, and mortgage payments may become difficult for low-income cancer patients to afford. In a qualitative study of cancer patients and survivors with housing needs, the participants who had been homeowners when they commenced treatment had lost their homes to foreclosure after falling behind on mortgage payments [2]. Potentially burdensome housing costs and home loss, and the stress they entail, could be contributing factors to food insecurity among renters and homeowners.…”

“…Low-income, immigrant, and minority cancer patients, for whom a cancer diagnosis can be an extreme financial burden added to an already financially precarious situation [1], can be particularly affected by poor housing conditions and food insecurity [2]. Adequate housing and food are two fundamental human rights and are essential contributors to health [3][4][5][6].…”

“…Housing insecurity is also a barrier to having a usual source of health care and is associated with postponing medical care, missing appointments, and higher hospitalization rates among low-income adults [14]. A qualitative study among NYC cancer patients/survivors identified housing needs as housing expenses (e.g., rent, mortgage, and utilities), housing loss, crowded/unstable housing, and housing conditions, accessibility, and safety [2].…”

Providing Appropriate Pancreatic Cancer Care for People Experiencing Homelessness: A Surgical Perspective

“…Patients experiencing homelessness often have other concerns besides health care, such as housing, transportation, and childcare. 63,64 Programs that address barriers to care, such as transport vouchers, and provide access to basic needs, such as food, shelter, and safety, can allow patients to direct more of their time and energy toward their health care needs.…”

Asking the Right Questions

“…A recently reported survey of cancer patients in New York City showed that housing needs across six categories (cost, home loss, stability, conditions, accessibility, and safety) were often interrelated and emerged both before and after a cancer diagnosis. 1 A study of primary care patients found that 40 percent had food insecurity. 2 These studies highlight the need to ensure that we are asking the right questions of our patients.…”