Worry About Daily Financial Needs and Food Insecurity Among Cancer Survivors in the United States

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  • a Surveillance and Health Services Research Program, American Cancer Society, Atlanta, Georgia;
  • b University of Southern California, Los Angeles, California; and
  • c The Center for Health Research, Kaiser Permanente, Portland, Oregon.
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Background: A cancer diagnosis can impose substantial medical financial burden on individuals and may limit their ability to work. However, less is known about worry for nonmedical financial needs and food insecurity among cancer survivors. Methods: The National Health Interview Survey (2013–2017) was used to identify cancer survivors (age 18–39 years, n=771; age 40–64 years, n=4,269; age ≥65 years, n=7,101) and individuals without a cancer history (age 18–39 years, n=53,262; age 40–64 years, n=60,141; age ≥65 years, n=30,261). For both cancer survivors and the noncancer group, adjusted proportions were generated for (1) financial worry (“very/moderately/not worried”) about retirement, standard of living, monthly bills, and housing costs; and (2) food insecurity (“often/sometimes/not true”) regarding whether food would run out, the fact that food bought did not last, and the inability to afford balanced meals. Further adjusted analyses examined intensity measures (“severe/moderate/minor or none”) of financial worry and food insecurity among cancer survivors only. Results: Compared with individuals without a cancer history, cancer survivors aged 18 to 39 years reported consistently higher “very worried” levels regarding retirement (25.5% vs 16.9%; P<.001), standard of living (20.4% vs 12.9%; P<.001), monthly bills (14.9% vs 10.3%; P=.002), and housing costs (13.6% vs 8.9%; P=.001); and higher “often true” levels regarding worry about food running out (7.9% vs 4.6%; P=.004), food not lasting (7.6% vs 3.3%; P=.003), and being unable to afford balanced meals (6.3% vs 3.4%; P=.007). Findings were not as consistent for cancer survivors aged 40 to 64 years. In contrast, results were generally similar for adults aged ≥65 years with/without a cancer history. Among cancer survivors, 57.6% (age 18–39 years; P<.001), 51.9% (age 40–64 years; P<.001), and 23.8% (age ≥65 years; referent) reported severe/moderate financial worry intensity, and 27.0% (age 18–39 years; P<.001), 14.8% (age 40–64 years; P<.001), and 6.3% (age ≥65 years; referent) experienced severe/moderate food insecurity intensity. Lower income and higher comorbidities were generally associated with greater intensities of financial worry and food insecurity in all 3 age groups. Conclusions: Younger cancer survivors experience greater financial worry and food insecurity. In addition to coping with medical costs, cancer survivors with low income and multiple comorbidities struggle to pay for daily living needs, such as food, housing, and monthly bills.

Submitted May 1, 2019; accepted for publication September 12, 2019.

Author contributions: Study concept and design: All authors. Statistical analysis: Zheng. Manuscript preparation: Zheng. Interpretation of results, manuscript revision, approval of final version: All authors.

Disclosures: Dr. Zheng has disclosed that he has received grant/research support from AstraZeneca, and that he is employed by the American Cancer Society, which receives grants from private and corporate foundations, including foundations associated with companies in the health sector for research. Dr. Banegas has disclosed that has received grant/research support from AstraZeneca. The remaining authors have disclosed that they have not received any financial consideration from any person or organization to support the preparation, analysis, results, or discussion of this article.

Correspondence: Zhiyuan Zheng, PhD, Surveillance and Health Services Research Program, American Cancer Society, 250 Williams Street, Atlanta, GA 30303. Email: jason.zheng@cancer.org
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