Abstract PR07: Racial differences in financial toxicity among metastatic breast cancer patients
Authors: Samuel Cleo A. , Spencer Jennifer C. , Manning Michelle L. , Rosenstein Donald L. , Reeder-Hayes Katherine E. , Sellers Jean B. , Wheeler Stephanie B. 
Published: August 2020

Abstract
Background: Awareness of the significant financial burden and distress that cancer patients experience (i.e., “financial toxicity”) is gaining traction in the oncology community. While racial differences in cancer care are well documented, less is known about racial variations in the financial impact of cancer care, particularly among patients with costly incurable disease. Using data from a national survey of racially diverse patients with metastatic breast cancer, we examined racial/ethnic patterns in financial burden due to cancer.
Methods: We partnered with the Metastatic Breast Cancer Network to conduct a 20-minute online survey of metastatic breast cancer patients over a 2-week period in 2018. Study participants responded to items assessing sociodemographic characteristics, communication with providers regarding costs, financial distress, strategies for managing cancer-related costs, and emotional well-being. We evaluated and compared financial outcomes among Hispanics, non-Hispanic Blacks, and non-Hispanic Whites.
Results: Our analysis included 1,119 respondents from 41 states, including 214 Hispanics (19%), 130 non-Hispanic Blacks (12%), and 775 non-Hispanic Whites (69%). Compared with non-Hispanic Whites, Hispanics were more likely to report refusing or delaying treatment due to costs (81% vs. 41%, p&lt;.001), applying for disability (66% vs. 35.1%, p&lt;.001), avoiding treatment for other medical problems (54% vs. 34%, p&lt;.001), and skipping payments on non-medical bills (70% vs. 13%, p&lt;.001). Non-Hispanic Blacks were more likely than non-Hispanic Whites to report refusing or delaying treatment due to costs (91% vs. 41%, p&lt;.001), skipping payments on non-medical bills (32% vs. 13%, p&lt;.001), and being contacted by a collections agency (87% vs. 46%, p&lt;.001). In contrast, non-Hispanic Whites more often reported skipping a vacation to help manage their cancer care costs than Hispanics and non-Hispanic Blacks (46.1% vs. 36.4% vs. 13.8%, respectively, p&lt;.05). Moreover, compared with non-Hispanic Whites and Blacks, Hispanics reported more severe financial distress associated with uncertainty about the cost of their cancer care (6.6% vs. 8.5% vs 47.4%, respectively, p&lt;.001).
Conclusions: Racial/ethnic differences exist in financial burden among metastatic breast cancer patients, with patients of color experiencing more financial harm than their White counterparts. Given the negative impact of financial strain on patient well-being and treatment decision-making, and longstanding disparities in cancer outcomes, equity must be a guiding principle in strategies aimed at addressing financial toxicity in cancer patients.
This abstract is also being presented as Poster B024.
Citation Format: Cleo A. Samuel, Jennifer C. Spencer, Michelle L. Manning, Donald L. Rosenstein, Katherine E. Reeder-Hayes, Jean B. Sellers, Stephanie B. Wheeler. Racial differences in financial toxicity among metastatic breast cancer patients [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr PR07.