Abstract PO-078: Delaying and forgoing care due to cost among rural cancer survivors
Authors: Falk Derek S. , Winkfield Karen E. , Tooze Janet A. , Shore Kelsey , Strom Carla , Weaver Kathryn E. 
Published: December 2020

Abstract
Purpose: Financial hardship, including delaying/forgoing services because of cost, is reported by approximately 30% of an estimated 16.9 million cancer survivors. However, hardship is poorly assessed and interventions sporadically implemented for survivors. The objective of this study is to assess factors associated with delaying and forgoing care services due to cost to inform a patient navigation program for rural cancer survivors. Methods: Adults with a cancer diagnosis who were 6 months or more post-definitive treatment or were receiving on-going maintenance therapy were identified for a cross-sectional mailed survey through the electronic medical record. Participants were predominately residents of one of eight priority rural counties in Northwest North Carolina (all resided in a zip-code defined by a Rural- Urban Commuting Area [RUCA] code of 4-10). Items from the 2019 National Health Information Survey (NHIS) assessed delayed/foregone medical care. Univariate statistics described the sample distribution and prevalence of delaying/forgoing care. Participants were randomized into two incentive groups ($2 bill with the survey mailing vs a $10 gift card upon completion). Chi-square tests examined the factors associated with delaying/forgoing services by demographic and cancer characteristics. Results: The survey response rate was 22.0%; 451 complete surveys were included in the present analyses. Enrolled survivors (49.7% female) were predominately non-Hispanic white (96.2%), with a mean age of 69 years, and 69.0% were 5 years or more post diagnosis. The most common cancer sites were prostate (21.5%), breast (19.7%), and colorectal (7.3%). Delayed medical care was reported by 16.2% of the sample. The prevalence of forgoing care due to cost was 6.4% for medical care, 12.3% for medications, 6.4% for mental health, and 7.0% for medical tests. Chi-square tests found significant differences by age, gender, and radiation treatment status (yes/no), with higher prevalence of delaying care among survivors aged 41-64 vs younger and older survivors (34.1% vs 27.2% and 8.8%, P&lt;0.001), females vs males (22.4% vs 10.4%, P&lt;0.001), and those treated with radiation therapy compared to those who were not (21.0% vs 13.2%, P=0.03). Survivors aged 18-40 compared to older survivors (18.8% vs 13.4% [aged 41-64] and 3.2% [aged 65+], P&lt;0.001), and females vs male survivors (10.7% vs 3.2%, P=0.006) were also more likely to report forgoing care due to cost. Discussion: A minority of post- treatment rural cancer survivors report delaying and forgoing medical care because of cost. Patient navigation programs should prioritize ongoing screening efforts for financial hardship among younger and female rural survivors after initial treatment completion.
Citation Format: Derek S. Falk, Karen E. Winkfield, Janet A. Tooze, Kelsey Shore, Carla Strom, Kathryn E. Weaver. Delaying and forgoing care due to cost among rural cancer survivors [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-078.