Xing Jiazhang, Han Xuesong, Nipp Ryan D, Hussaini S M Qasim, Wang Tianci, Yabroff K Robin, Jiang Changchuan
Department of Medicine, Sinai Hospital of Baltimore, Baltimore, MD.
Department of Surveillance and Health Equity Science, American Cancer Society, Atlanta, GA.
JCO Oncol Pract. 2025 Jun 20:OP2500045. doi: 10.1200/OP-25-00045.
Cancer survivors often experience financial hardship, negatively affecting quality of life, health care use, and survival. Health-related social needs (HRSNs)-such as food/housing insecurity and transportation barriers-are prevalent among survivors and may correlate with financial hardship. Research exploring associations between financial hardship and HRSNs is limited. This study quantifies these associations in a nationally representative US sample.
We identified adult cancer survivors from the 2013 to 2018 National Health Interview Survey. Medical financial hardship was defined as (1) problems paying medical bills, (2) worry about medical bills, or (3) delaying/forgoing care because of cost. HRSNs were defined as (1) food insecurity, (2) housing insecurity, and (3) transportation barriers to care. Multivariable logistic regression models were used to assess associations between financial hardship and each HRSN, controlling for socioeconomic characteristics.
Among 13,626 cancer survivors, 4,623 (34.2%) reported medical financial hardship. Survivors with financial hardship were significantly more likely to report any HRSN compared with those without hardship (53.1% 8.7%, adjusted odds ratio [aOR], 6.99 [95% CI, 6.06 to 8.07]). This association persisted across household income levels (interaction = .58). Specifically, survivors with financial hardship were more likely to experience food insecurity (21.9% 2.2%, aOR, 5.49 [95% CI, 4.38 to 6.87]), housing insecurity (44.6% 6.4%, aOR, 7.14 [95% CI, 6.1 to 8.35]), and transportation barriers to care (6.6% 1.1%, aOR, 3.1 [95% CI, 2.27 to 4.22]), than survivors without hardship.
Medical financial hardship among cancer survivors is strongly associated with HRSNs, such as food, housing, and transportation insecurity, across income levels. These findings highlight the importance of systematic screening of financial hardship and HRSNs, along with providing comprehensive socioeconomic support to address the needs of all cancer survivors, regardless of their household income.
癌症幸存者常常经历经济困难，这对生活质量、医疗保健利用和生存产生负面影响。与健康相关的社会需求（HRSNs），如食品/住房不安全和交通障碍，在幸存者中很普遍，并且可能与经济困难相关。探索经济困难与HRSNs之间关联的研究有限。本研究在美国具有全国代表性的样本中对这些关联进行量化。
我们从2013年至2018年全国健康访谈调查中识别出成年癌症幸存者。医疗经济困难被定义为：（1）支付医疗账单有问题，（2）担心医疗账单，或（3）因费用而推迟/放弃治疗。HRSNs被定义为：（1）食品不安全，（2）住房不安全，以及（3）就医的交通障碍。多变量逻辑回归模型用于评估经济困难与每种HRSN之间的关联，并对社会经济特征进行控制。
在13,626名癌症幸存者中，4,623名（34.2%）报告有医疗经济困难。与没有经济困难的幸存者相比，有经济困难的幸存者报告任何一种HRSN的可能性显著更高（53.1%对8.7%，调整后的优势比[aOR]为6.99[95%置信区间，6.06至8.07]）。这种关联在不同家庭收入水平中均持续存在（交互作用P值 =.58）。具体而言，与没有经济困难的幸存者相比，有经济困难的幸存者更有可能经历食品不安全（21.9%对2.2%，aOR为5.49[95%置信区间，4.38至6.87]）、住房不安全（44.6%对6.4%，aOR为7.14[95%置信区间，6.1至8.35]）以及就医的交通障碍（6.6%对1.1%，aOR为3.1[95%置信区间，2.27至4.22]）。
癌症幸存者中的医疗经济困难与HRSNs，如食品、住房和交通不安全，在不同收入水平上都密切相关。这些发现凸显了系统筛查经济困难和HRSNs的重要性，以及提供全面的社会经济支持以满足所有癌症幸存者需求的重要性，无论其家庭收入如何。
