Background: Most of the estimated 12 million US cancer survivors live years after diagnosis, emphasizing the importance of health care access for survivors. Ethnic minority persons have reduced access to many health care services, but it is not known if having cancer might influence disparities. This research compares individuals with and without a history of cancer on prevalence of forgoing different types of health care services due to cost and examines whether ethnic minority survivors report poorer access to care.
Method: We identified 6,602 adult cancer survivors (64.3% female; 4.8% Hispanic, 6.4% Non-Hispanic Black (NHB), 88.8% Non-Hispanic White (NHW); 57.8% more than 5 years post-diagnosis, 52.4% 65 years and older) and 104,364 individuals with no history of cancer from the United States National Health Interview Survey (NHIS)-2003–2006. The NHIS is an annual, in person, nationwide survey of approximately 30,000–40,000 households assessing many health outcomes. During the survey, individuals were asked if they did not get medical care, prescription medications, dental care, or mental health services during the past year because of concerns about cost. To account for the weighting associated with a complex sampling design, we used SUDAAN 9.0 to conduct logistic regression analyses. A significant interaction between ethnicity and cancer history would indicate that disparities among survivors differ from those in the general adult population.
Results: The prevalence of forgoing care due to cost among cancer survivors was 7.8% for medical care, 9.9% for prescription medication, 11.3% for dental care, and 2.7% for mental health care. When compared with NHW survivors, Hispanic and NHB cancer survivors were more likely to forgo prescription medications (Hispanic OR = 2.14, 95% CI 1.52–3.00 & NHB OR = 1.87, 95% CI 1.38–2.54) and dental care ((Hispanic OR = 2.31, 95% CI 1.68–3.17 & NHB OR=1.57, 95% CI 1.18–2.10). Hispanic survivors were also more likely to not get medical care compared to NHW survivors (OR= 1.55, 95% CI 1.05–2.29). Disparities among cancer survivors were largely reflective of those in the general adult population. After adjusting for education, health insurance coverage, and non-cancer medical comorbidities, none of the interactions between ethnicity and cancer history were statistically significant in those persons 65 years of age and older. For those persons less than 65 years of age, there were significant interactions between Hispanic ethnicity and cancer history for forgoing dental care and prescription medications. After adjustment, Hispanic adults without a history of cancer were less likely than NHW adults to forgo medications (OR= .76, p <.0001) and dental care (OR= .74, p <.0001), but this pattern reversed for cancer survivors. Hispanic survivors were more likely to forgo prescription medications (OR= 1.19, p= .02) and dental care (OR= 1.31, p<.001) compared to NHW survivors.
Conclusions: More than a million cancer survivors living in the United States report that they did not get medical care that they needed because of concerns about cost. Hispanic and NHB survivors are at even greater risk of not receiving needed care. Future research needs to examine the impact of forgoing care on survivors' long-term physical and mental well-being and survival.
Second AACR International Conference on the Science of Cancer Health Disparities— Feb 3–6, 2009; Carefree, AZ