In a study reported in JCO Oncology Practice, Panzone et al found that compared to White patients with a history of cancer, Black patients and ‘other race’ patients—but not Hispanic patients—were significantly more likely to have experienced financial toxicity due to cancer.
Study Details
The cross-sectional study involved data on patients with a history of cancer from the U.S. Health Information National Trends Survey for 2012, 2014, and 2017. Patients were surveyed by mail with monetary compensation as an incentive.
The primary analysis involved the answer to two questions:
- “Has cancer hurt you financially? [financial toxicity]”
- “Have you been denied health insurance because of cancer?”
Key Findings
A total of 1,328 patients (59% female) were included in the analysis. Of these, 997 (75.1%) were White, 140 (10.5%) were Black, 129 (9.7%) were Hispanic, and 62 (4.7%) were ‘other race’.
Overall, 95.4% of White patients, 83.7% of Black patients, 90.0% of Hispanic patients, and 93.5% of patients of other races had health insurance (overall P < .001)
White patients were the least likely to have received no cancer treatment (6.0%) compared with 15% of Black patients, 17.8% of Hispanic patients, and 9.7% of patients of other races (overall P < .001). White patients were the most likely to have undergone surgery (77%), compared with 60% of Black patients, 55% of Hispanic patients, and 74% of patients of other races (overall P < .001).
On multivariate analysis, compared with White patients, Black patients (odds ratio [OR] = 5.00, 95% confidence interval [CI] = 2.45–10.21, P < .001), but not Hispanic patients (OR = 2.19, 95% CI = 0.95–5.07, P = .068) or patients of other races (OR = 1.49, 95% CI = 0.42–5.21, P = .536), were significantly more likely to be denied health insurance. Compared with White patients, Black patients (OR = 2.45, 95% CI = 1.52–3.94, P < .001) and patients of other races (OR = 2.42, 95% CI = 1.25–4.70, P = .009), but not Hispanic patients (OR = 1.49, 95% CI = 0.92–2.44, P = .109), were significantly more likely to report being hurt financially because of cancer.
Analysis of financial toxicity according to genitourinary, gynecologic, gastrointestinal, and breast cancer groups showed a statistically significant difference only for genitourinary cancers; rates of being hurt financially among those with genitourinary cancers were 36.7% for White patients, 62.5% for Hispanic patients, 59.3% for Black patients, and 22.2% for patients of other races (overall P = .004).
The investigators concluded, “Our data suggest that race is significantly associated with financial toxicity because of cancer. Awareness of racial inequality with regards to financial toxicity should be raised among health-care workers.”
Hanan Goldberg, MD, MSc, of the Urology Department, SUNY Upstate Medical University, Upstate University Hospital, Syracuse, is the corresponding author for the JCO Oncology Practice article.
Disclosure: For full disclosures of the study authors, visit ascopubs.org.
