title: Long-term financial burden of breast cancer: experiences of a diverse cohort of survivors identified through population-based registries.
abstract: OBJECTIVE
  To evaluate the financial experiences of a racially and ethnically diverse cohort of long-term breast cancer survivors (17% African American, 40% Latina) identified through population-based registries.
  
  
  METHODS
  Longitudinal study of women diagnosed with nonmetastatic breast cancer in 2005 to 2007 and reported to the SEER registries of metropolitan Los Angeles and Detroit. We surveyed 3,133 women approximately 9 months after diagnosis and 4 years later. Multivariable models evaluated correlates of self-reported decline in financial status attributed to breast cancer and of experiencing at least one type of privation (economically motivated treatment nonadherence and broader hardships related to medical expenses).
  
  
  RESULTS
  Among 1,502 patients responding to both surveys, median out-of-pocket expenses were ≤ $2,000; 17% of respondents reported spending > $5,000; 12% reported having medical debt 4 years postdiagnosis. Debt varied significantly by race: 9% of whites, 15% of blacks, 17% of English-speaking Latinas, and 10% of Spanish-speaking Latinas reported debt (P = .03). Overall, 25% of women experienced financial decline at least partly attributed to breast cancer; Spanish-speaking Latinas had significantly increased odds of this decline relative to whites (odds ratio [OR], 2.76; P = .006). At least one privation was experienced by 18% of the sample; blacks (OR, 2.6; P < .001) and English-speaking Latinas (OR, 2.2; P = .02) were significantly more likely to have experienced privation than whites.
  
  
  CONCLUSIONS
  Racial and ethnic minority patients appear most vulnerable to privations and financial decline attributable to breast cancer, even after adjustment for income, education, and employment. These findings should motivate efforts to control costs and ensure communication between patients and providers regarding financial distress, particularly for vulnerable subgroups.
authors.affiliation: Reshma Jagsi, Kent A. Griffith, Steven J. Katz, and Sarah T. Hawley, University of Michigan, Ann Arbor, MI; John A.E. Pottow, University of Michigan Law School, Ann Arbor, MI; Cathy Bradley, Virginia Commonwealth University, Richmond, VA; Ann S. Hamilton, University of Southern California, Los Angeles, CA; and John Graff, Rutgers, Cancer Institute of New Jersey, Robert Wood Johnson Medical School, New Brunswick, NJ.
authors.forename: Reshma
authors.initials: R
authors.lastname: Jagsi
authors.forename: John A E
authors.initials: JA
authors.lastname: Pottow
authors.forename: Kent A
authors.initials: KA
authors.lastname: Griffith
authors.forename: Cathy
authors.initials: C
authors.lastname: Bradley
authors.forename: Ann S
authors.initials: AS
authors.lastname: Hamilton
authors.forename: John
authors.initials: J
authors.lastname: Graff
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Katz
authors.forename: Sarah T
authors.initials: ST
authors.lastname: Hawley
mesh_terms: D000328:Adult; D001741:Black or African American; D000368:Aged; D001943:Breast Neoplasms / Q000191:economics* / Q000208:ethnology; D015331:Cohort Studies; D017281:Cost of Illness; D005260:Female; D006630:Hispanic or Latino; D006801:Humans; D008137:Longitudinal Studies; D015141:Los Angeles; D008824:Michigan; D008875:Middle Aged; D012042:Registries; D018426:SEER Program; D011795:Surveys and Questionnaires; D017741:Survivors; D044465:White People; D055815:Young Adult