Financial Hardship and Risk Factors in Patients With Cancer Receiving Routine Clinical Care

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In a study reported in JCO Oncology Practice, Voleti et al identified the proportion of patients with cancer receiving routine clinical care who reported financial hardship and analyzed risk factors for financial hardship. The researchers found that patients who reported experiencing financial hardship were at an increased risk of mortality.

Study Details

The study included 31,154 patients treated at Mayo Clinic Cancer Centers who completed a financial hardship screen at least once between 2018 and 2020. Demographics, disease state, and mortality data were extracted from medical records.

Key Findings

Among the 31,154 patients, 4,250 (14%) reported financial hardship. Significantly higher likelihood of financial hardship was observed for:

  • Racial/ethnic minority patients (eg, odds ratios [OR] of 1.52, P <.001, for Hispanic vs non-Hispanic; 1.60, P < .001, for Black vs White)
  • Those who were unemployed/disabled vs working/student (OR = 2.31, P < .001)
  • Those who were single (OR = 2.13, P < .001) or divorced/separated/widowed (OR = 2.25, P < .001) vs married/in a life partnership
  • Those from disadvantaged neighborhoods (ORs of 1.64 to 3.13, all P < .001, for 2nd to 5th area deprivation index quintiles vs 1st quintile)
  • Those who were self-paying or had government insurance (ORs of 3.15 for Medicaid, 1.47 for Medicare, and 2.73 for self-paying, all P < .001, vs commercial insurance).

Compared with patients with breast cancer, financial hardship was more likely among those with gastrointestinal cancer (OR = 1.51, P < .001) and those with lung or head/neck cancer (OR = 1.72, P < .001).

Factors associated with reduced likelihood of financial hardship included: older age (ORs of 1.50 to 2.88, all P < .001, for every age group vs ≥ 70 years); being retired (OR = 0.88, P = .03, vs working/student); and living farther from their cancer center (OR = 0.76, P < .001, for 5th vs 1st quintile of distance from center).

In an analysis using propensity-score weighting to account for differences in demographic and clinical factors between 3,834 patients with financial hardship and 24,589 patients without financial hardship with full available data, those with financial hardship had a significantly increased risk of mortality (hazard ratio = 1.46, 95% confidence interval = 1.31–1.63, P < .001).

The investigators concluded, “Our study identified key groups more likely to report financial hardship in a relatively affluent population at a large cancer center and showed an adverse association between financial hardship and survival. Further research is needed to develop clinical care pathways for patients at high risk for worse financial and clinical outcomes.”

Sandeep S. Voleti, BS, of the Mayo Clinic Alix School of Medicine, Scottsdale, is the corresponding author for the JCO Oncology Practice article.

Disclosure: The study was supported by Mayo Clinic Cortese and Predolin Research Funding. For full disclosures of the study authors, visit

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.