Abstract C55: Understanding the financial consequences of cancer: A qualitative study of racially and geographically diverse survivors
Authors: Hastert Theresa A. , Mabunda Lorna M. , Berry-Bobovski Lisa , Foster Tanina , Eggly Susan 
Published: February 2019

Abstract
Background: Cancer survivors commonly face serious financial hardships that can impact their physical and financial health. African-American survivors, who are at greater risk of experiencing financial hardship than whites, and survivors in rural areas are often under-represented in this research, and ways in which financial hardship might differ by race and geography are not well understood. The purpose of this study is to gain a deeper understanding of the experiences of financial hardship of racially and geographically diverse cancer survivors using qualitative research methods.
Study Design: We conducted a total of 7 focus groups, 5 in Detroit (2 among white and 3 among African-American survivors) and 2 among white survivors in rural communities in Michigan's Lower Peninsula. Detroit survivors were recruited from participants in the Cancer Survivorship in Metropolitan Detroit cohort study and included white and African-American adults diagnosed with breast, colorectal, lung, or prostate cancer since January 1, 2013. Rural survivors were recruited from community hospitals using the same criteria with regard to cancer site and dates of diagnosis. Each group included 3-6 survivors for a total of 32 participants across all groups. A semistructured discussion guide was developed based on a review of the literature related to financial hardship among cancer survivors. Topics included the types of financial costs experienced, strategies used to address those costs, the care-related and emotional impact of those costs, and the impact of those costs on future financial health and decision-making. All focus groups were audio- and video-recorded and verbatim transcripts were created from those recordings. Coding was conducted by 3 members of the study team. At least 2 individuals coded each transcript. Inter-rater reliability was tested and found to be satisfactory (Cohen's kappa = 0.70 for both LM and TF relative to TH). Coding and inter-rater reliability testing was conducted using Dedoose.
Results: Overall, 6 main themes emerged related to the financial consequences of cancer: care-related costs, access to/paying for care, practical considerations, social support, knowledge and advocacy, and survivors' outlook. Participants in each group emphasized the impact of care-related costs, of insurance in paying for care, and the lack of knowledge of what their costs would be until bills began arriving after treatment. The importance of both individual and institutional social support in navigating the financial impact of cancer was emphasized, and several participants also discussed having to balance their care with caregiving responsibilities for others (e.g., disabled adult children) and the further financial and emotional toll that their treatment presented to their families. Although each group discussed each of the main themes, within those themes, survivors in the African-American focus groups further emphasized difficulty accessing timely and appropriate care due to cost and insurance coverage issues, difficulty in maintaining employment and the subsequent effects on their financial situation, and the centrality of faith and their relationship with God in their approach to handling financial stresses related to cancer. Rural survivors particularly emphasized the importance of logistical considerations with regard to traveling to and from treatment appointments and the impact of both monetary and time costs on their treatment decisions.
Conclusions: Although several themes were consistent among survivors from diverse backgrounds and life experiences, important differences in the financial consequences of cancer were observed by both race and geography. These findings can inform both future research and efforts to improve financial hardship after cancer for diverse survivor populations.
Citation Format: Theresa A. Hastert, Lorna M. Mabunda, Lisa Berry-Bobovski, Tanina Foster, Susan Eggly. Understanding the financial consequences of cancer: A qualitative study of racially and geographically diverse survivors [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr C55.