Abstract C22: Cancer-related financial burden, employment, and health among rural cancer survivors
Authors: Hallgren Emily , Carnahan Leslie R. , Zimmermann Kristine , Molina Yamile 
Published: February 2019

Abstract
Purpose: A growing body of literature has begun to document rural-urban disparities among cancer survivors. Rural survivors report worse mental health, health behaviors (e.g., smoking, physical activity), and self-rated health relative to urban counterparts. There is a need to determine modifiable determinants of these disparities, including work. Only one study of which we are aware has explored financial determinants of health: Weaver and colleagues found rural survivors were more likely to report not being able to work because of health-related reasons than urban counterparts. Little, however, is known about cancer-related financial burden during (e.g., filing for bankruptcy) and after treatment (e.g., not returning to work).
Objective: This study seeks to: 1) characterize cancer-related financial burden and employment among rural survivors and 2) examine how these factors pertain to their self-rated health.
Methods: We drew from an ongoing larger study that is characterizing the health needs of 600 rural cancer survivors and caregivers of cancer patients throughout Illinois State. Participants were recruited via non-probability based sampling methods, including physical flyers placed in rural community organizations (e.g., churches, hair salons, support groups), public health departments, clinics, hospitals, and cancer centers as well as at cancer-related events (e.g., Relay for Life); word of mouth; and electronic flyers distributed via websites, listservs, and social media. Interested participants contacted staff via the study website or phone number. To be eligible for the study, individuals self-reported: 1) being 18 years or older, 2) identifying as a survivor and/or caregiver, and 3) living in a rural part of Illinois State. After screening and providing informed consent, participants completed surveys by mail, phone, or website. Participants received $15 for their time and effort.
Results: Since February, we have recruited 72 current survivors, 84% of whom completed the survey online and 27% of whom also self-reported having been caregivers of cancer patients during their lifetime. Our sample was largely female, married, and non-Latino White (NLW). Survivors in the sample are well-educated overall, with 52% holding a bachelor's degree or above. The median annual household income (AHI) was $50,001 to $75,000, with 40% reporting an AHI of more than $75,000. Approximately 26% of respondents indicated cancer-related financial burden. With regard to work, 52% indicated cancer-related work stoppage, 18% indicated they did not return to work, and 40% indicated a reduced workload during treatment. Cancer-related financial burden was associated with family income, in that work stoppage was associated with lower annual household income (B = -0.32, 95% CI [-0.14, -1.35], p = .02). Finally, we examined how cancer-related financial burdens and employment factors were associated with rural residents' self-rated health. Cancer-related employment factors were associated with self-rated health, in that returning to work at a different job (as opposed to the same job) was associated with lower self-rated health (B = -.49, 95% CI [-.34, -.06], p = .008).
Discussion: Our study suggests that work may be an important determinant of rural-urban disparities among cancer survivors. Specifically, financial burden and work difficulties were fairly prevalent among our sample. Returning to work at a different job was significantly associated with lower self-rated health. Limitations include small sample size, generalizability, and an inability to make causal inferences. Our next steps will be to further explore how these work-related factors pertain to specific health behaviors, mental health, and physical health outcomes among survivors and caregivers.
Citation Format: Emily Hallgren, Leslie R. Carnahan, Kristine Zimmermann, Yamile Molina. Cancer-related financial burden, employment, and health among rural cancer 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 C22.