Factors correlated with financial hardship among cancer patients during the COVID-19 pandemic

Abstract

Purpose Financial hardship from cancer care is associated with poor patient outcomes. Economic disruption during the COVID-19 pandemic may have exacerbated patients’ financial concerns. We explore how social deprivation index (SDI), clinical, and treatment-related factors impacted financial hardship in this observational secondary analysis using data collected prospectively during implementation of financial hardship screening from our NCI-designated center during COVID-19. Methods Adults aged ≥18 years undergoing active treatment for stage 0-IV breast or lung cancer and who completed a 5-point Likert response-item screening for financial difficulty between 11/2020 and 11/2021 were included. Generalized estimating equations assessed associations between quartiles of zip-code level SDI, a composite obtained using data from US Census and American Community Survey, and binary outcome of financial hardship adjusting for relevant covariates. Results Of 2245 patients, 87% identified as White, 9% as Black, 2% as Asian. The majority of patients identified as non-Hispanic (99%). Median age was 62 years old (IQR 53–71). The majority were treated for breast cancer (79%). Significant financial hardship (Likert responses ≥2) was reported by 7%. Most were married, had managed-care insurance, resided in urban settings, and had early-stage cancers (all p < 0.001). Of those included, 83% received surgery, 52% received chemotherapy, and 65% received radiation. Compared to the lowest SDI quartile, penultimate and highest quartiles were associated with financial hardship (Q3 aOR 1.86; 95%CI 1.13–3.05); Q4 aOR 2.05; 95%CI 1.15–3.63). Younger age, Black race, comorbidities, radiation, and chemotherapy were also associated with greater financial hardship (p < 0.05). Conclusion In this study, greater SDI, younger age, Black race, comorbidities, receipt of radiation and/or chemotherapy were associated with financial hardship. These factors may guide focused screening of vulnerable populations to assist with equitable access to resources that offset the economic effects of cancer care.