Abstract C13: How does the financial impact of cancer differ by race? Results from the Cancer Survivorship in Metropolitan Detroit cohort study
Authors: Hastert Theresa A. , Hamel Lauren M. , Baird Tara , Albrecht Terrance L. , Schwartz Ann G. , Simon Michael S. , Vigneau Fawn , Beebe-Dimmer Jennifer L. 
Published: March 2017

Abstract
Background: Previous research suggests that financial burdens due to cancer are more common in African-American than white survivors, but it is not known whether or how the types of burdens experienced differ by race.
Methods: This study utilizes preliminary data from the Cancer Survivorship in Metropolitan Detroit (CSMD) cohort. African-American and white adults ages 20-79 are eligible to join the cohort if they were identified through the Metropolitan Detroit Cancer Surveillance System as having been diagnosed with a first primary breast, colorectal, lung, or prostate cancer since January 1, 2013 and were diagnosed and/or treated at the Karmanos Cancer Institute. To date, 695 (281 white, 414 African-American) of the targeted 1000 survivors have completed the baseline questionnaire online or over the phone. Data collected include demographic and socioeconomic characteristics, medical history, and financial burden measures including indicators of whether participants sold assets or borrowed money to pay for cancer care; limited care due to cost; experienced a decrease in income since diagnosis; and whether they are currently in debt due to cancer expenses. This abstract presents results of bivariate analyses and odds ratios (OR) and 95% confidence intervals (CI) from logistic regressions controlling for age, sex, treatment, and insurance.
Results: Overall, 52.4% of survivors experienced some form of financial burden related to cancer, and prevalence was higher in African-American (56.6%) than in white survivors (46.3%; p=0.011). A marginally higher proportion of white (24.7%) than African-American survivors (19.2%; p=0.08) used existing assets to pay for cancer care, including higher proportions who withdrew money from savings (14.6% vs. 9.2%; p=0.027) or retirement accounts (7.8% vs. 3.4%; p=0.009). Although an identical proportion (9.8%) of white and African-American survivors borrowed money from family or friends, more African-American (31.2%) than white (18.1%; p&lt;0.001) survivors were still in debt due to expenses related to cancer treatment. More African-American (21.3%) than white (14.6%; p=0.027) survivors also limited care due to cost concerns, including reporting that they needed to see a doctor in the past year but could not due to cost (15.1% vs. 9.1%; p=0.022) and that they skipped doses of prescribed medication to save money (8.8% vs. 5.4%; p=0.094). No differences were observed in the proportion of African-American and white survivors who sold stocks or other investments (1.2% vs. 2.1%), refused treatment due to cost (4.6% vs. 5.0%), or experienced a decrease in income due to cancer (30.2% vs. 27.3%). In adjusted analyses, African-American race remained associated with higher odds of being in debt due to cancer (OR: 2.09; 95% CI: 1.39, 2.14) and experiencing any form of economic burden (OR: 1.49, 95% CI: 1.04, 2.12) and marginally associated with skipping doses of prescribed medication (OR: 1.77 95% CI: 0.92, 3.42) and limiting care due to cost (OR: 1.46, 95% CI; 0.93, 2.28).
Implications: These findings suggest that although large proportions of both white and African-American survivors experience some form of financial burden related to cancer, a larger proportion of white survivors may be able to utilize existing resources to pay for cancer treatment, while a larger proportion of African-American survivors experience lasting debt or forego necessary care due to cost concerns. As research into the economic consequences of cancer survivorship continues and expands into the development of interventions to reduce their impacts, it is important to identify not only disparities in the overall prevalence of economic burden, but also in the forms those burdens take for distinct groups.
Citation Format: Theresa A. Hastert, Lauren M. Hamel, Tara Baird, Terrance L. Albrecht, Ann G. Schwartz, Michael S. Simon, Fawn Vigneau, Jennifer L. Beebe-Dimmer. How does the financial impact of cancer differ by race? Results from the Cancer Survivorship in Metropolitan Detroit cohort study. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr C13.