title: Forgoing medical care because of cost: assessing disparities in healthcare access among cancer survivors living in the United States.
abstract: BACKGROUND
  Many US cancer survivors live years after diagnosis, which emphasizes the importance of healthcare access for survivors. It is not known whether having cancer has an impact on disparities in healthcare access that are present in the general population. The objective of this study was to examine the prevalence of forgoing care because of financial concerns in a representative sample of US adults to determine whether cancer history and race/ethnicity are associated with the likelihood of forgoing medical care.
  
  
  METHODS
  Data from the US National Health Interview Survey (NHIS) from 2003 to 2006 were used to identify 6602 adult cancer survivors and 104,364 individuals who had no history of cancer. Self-reports of forgoing medical care services because of cost were analyzed according to cancer history and race/ethnicity using multivariate logistic regression.
  
  
  RESULTS
  The prevalence of forgoing care because of cost among cancer survivors was 7.8% for medical care, 9.9% for prescription medications, 11.3% for dental care, and 2.7% for mental healthcare. Cancer survivors aged<65 years were more likely to delay or forego all types of medical care compared with adults who did not have a history of cancer. Hispanic and black cancer survivors were more likely to forego prescription medications and dental care than white survivors. Disparities among cancer survivors largely were reflective of those in the general adult population.
  
  
  CONCLUSIONS
  More than 2 million US cancer survivors did not get 1 or more needed medical services because of financial concerns during the studied period. Future research needs to examine the impact of forgoing care on survivors' quality of life and survival.
authors.affiliation: Office of Cancer Survivorship, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland, USA. keweaver@wfubmc.edu
authors.forename: Kathryn E
authors.initials: KE
authors.lastname: Weaver
authors.forename: Julia H
authors.initials: JH
authors.lastname: Rowland
authors.forename: Keith M
authors.initials: KM
authors.lastname: Bellizzi
authors.forename: Noreen M
authors.initials: NM
authors.lastname: Aziz
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044383:Black People; D005102:Health Expenditures; D006297:Health Services Accessibility; D054625:Healthcare Disparities; D006630:Hispanic or Latino; D006801:Humans; D008875:Middle Aged; D009369:Neoplasms / Q000191:economics* / Q000628:therapy*; D017741:Survivors; D013997:Time Factors; D014481:United States; D044465:White People; D001741:Black or African American