Background: Financial hardship (FH) is common among cancer survivors and prevalence is often higher in non-white survivors. It is not known whether specific forms of FH are stronger predictors of financial distress than others, or if predictors of distress differ by race.

Methods: We utilized data from 500 (196 white, 304 African American) participants in the Detroit Research on Cancer Survivors pilot cohort. Adults ages 20-79 were eligible if they were diagnosed with a first primary breast, colorectal, lung, or prostate cancer since January 1, 2013; identified through the Metropolitan Detroit Cancer Surveillance System; and diagnosed/treated at the Karmanos Cancer Institute. Measures of financial hardship included decreased income, cancer-related debt, utilizing assets or borrowing money to pay for cancer care, refusing treatment or not seeing a doctor when needed due to cost, and skipping doses of prescribed medication to save money. Financial distress was measured using the validated Comprehensive Score for Financial Toxicity (COST), coded so that lower scores indicate higher distress (lower financial quality of life). We used backward selection models including demographic and socioeconomic factors to identify predictors of financial distress overall and separately for white and African American survivors.

Results: COST scores were 27.3 on average (SD: 10.9; 95% CI: 26.2, 28.3; range: 0-44), and were lower (more financial distress) in African American (24.5, 95% CI: 23.1, 25.8) than white survivors (31.0, 95% CI: 29.4, 32.5; p<0.001). Younger age, being unmarried, lower income, not being employed, and having Medicaid coverage were all associated with higher financial distress. Debt, decreased income, utilizing assets, skipping doses of prescribed medication, and needing a doctor but not going were each independently associated with more financial distress overall (all p=0.013). Debt was associated with distress among both white and African American survivors in race-specific models (p=0.005) and decreased income was associated with distress in white (p=0.013) and marginally associated (p=0.06) in African American survivors. Not going to the doctor when needed and utilizing assets (both p<0.001) predicted distress among white survivors, while refusing treatment due to cost (p=0.007) and skipping doses of prescribed medication to save money (p=0.007) predicted distress in African American survivors. Not going to a doctor when needed was more common in African American survivors, but more strongly associated with distress in white survivors (p-interaction=0.024). A similar pattern was observed for utilizing assets but was only marginally significant (p=0.08).

Conclusions: Several forms of financial hardship were strongly associated with financial distress after cancer, but their association with distress differed by race. Some forms of financial hardship that are more common in African American survivors are more strongly associated with financial distress among white survivors.

Citation Format: Theresa A. Hastert, Amanda R. Reed, Jennifer L. Beebe-Dimmer, Terrance L. Albrecht, Julia Mantey, Tara Baird, Ann G. Schwartz. Which forms of financial hardship predict financial distress among African American and white cancer survivors? [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 B032.