title: Are survivors who report cancer-related financial problems more likely to forgo or delay medical care?
abstract: BACKGROUND
  Financial problems caused by cancer and its treatment can substantially affect survivors and their families and create barriers to seeking health care.
  
  
  METHODS
  The authors identified cancer survivors diagnosed as adults (n=1556) from the nationally representative 2010 National Health Interview Survey. Using multivariable logistic regression analyses, the authors report sociodemographic, clinical, and treatment-related factors associated with perceived cancer-related financial problems and the association between financial problems and forgoing or delaying health care because of cost. Adjusted percentages using the predictive marginals method are presented.
  
  
  RESULTS
  Cancer-related financial problems were reported by 31.8% (95% confidence interval, 29.3%-34.5%) of survivors. Factors found to be significantly associated with cancer-related financial problems in survivors included younger age at diagnosis, minority race/ethnicity, history of chemotherapy or radiation treatment, recurrence or multiple cancers, and shorter time from diagnosis. After adjustment for covariates, respondents who reported financial problems were more likely to report delaying (18.3% vs 7.4%) or forgoing overall medical care (13.8% vs 5.0%), prescription medications (14.2% vs 7.6%), dental care (19.8% vs 8.3%), eyeglasses (13.9% vs 5.8%), and mental health care (3.9% vs 1.6%) than their counterparts without financial problems (all P<.05).
  
  
  CONCLUSIONS
  Cancer-related financial problems are not only disproportionately represented in survivors who are younger, members of a minority group, and have a higher treatment burden, but may also contribute to survivors forgoing or delaying medical care after cancer.
authors.affiliation: Outcomes Research Branch, Applied Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland.
authors.forename: Erin E
authors.initials: EE
authors.lastname: Kent
authors.forename: Laura P
authors.initials: LP
authors.lastname: Forsythe
authors.forename: K Robin
authors.initials: KR
authors.lastname: Yabroff
authors.forename: Kathryn E
authors.initials: KE
authors.lastname: Weaver
authors.forename: Janet S
authors.initials: JS
authors.lastname: de Moor
authors.forename: Juan L
authors.initials: JL
authors.lastname: Rodriguez
authors.forename: Julia H
authors.initials: JH
authors.lastname: Rowland
mesh_terms: D000328:Adult; D000368:Aged; D003695:Delivery of Health Care / Q000191:economics; D005260:Female; D005500:Follow-Up Studies; D005102:Health Expenditures; D006297:Health Services Accessibility / Q000191:economics; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000191:economics* / Q000523:psychology / Q000628:therapy; D057240:Patient Preference; D011379:Prognosis; D017741:Survivors / Q000523:psychology*; D028761:Withholding Treatment / Q000706:statistics & numerical data*
keywords: access to care; cancer; financial burden; health disparities; survivors
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