Brigham and Women's Hospital, Boston, MA
Ashley Odai-Afotey , Ruth Lederman , Naomi Y Ko , Haley Gagnon , Dawn L. Hershman , Katherine D. Crew , Nancy Lynn Keating , Daniel A. Gundersen , Anna C. Revette , Rachel A. Freedman
Background: Low-income and minority women are less likely to receive breast cancer treatments and have higher mortality rates compared with other women.We examined economic hardship, health literacy, and numeracy by race/ethnicity and whether these factors were associated with differences in receipt of recommended treatment. Methods: We conducted a telephone survey in 2018-2020 of adult women diagnosed with stage I-III breast cancer between 2013-2016 at three centers in Boston and New York. We asked women about treatment receipt and factors contributing to decision-making. We used X2 and Fischer exact tests to examine associations between economic distress, health literacy/numeracy, and treatment receipt by race/ethnicity. Results: Among 326 respondents (AAPOR cooperation rate 63-80% across sites), 55% were Non-Hispanic (NH) White, 23% were NH Black, and 14% Hispanic; 15% were Medicaid-insured. Due to item non-response, sample sizes ranged from 294-315 per question. A substantial proportion of women, and particularly Black and Hispanic women, reported economic distress, worse finances over time, and low literacy/numeracy (Table). Overall, 7% (n = 22) did not initiate at least one recommended treatment. Although we observed no differences in treatment by race/ethnicity (p = 0.70), those not initiating recommended treatment(s) reported more worry about paying large medical bills (52% vs. 27%) and covering visit costs (27 vs. 10%); p < .05 for both. Conclusions: In a diverse sample of breast cancer survivors, financial distress was common, particularly for non-White participants; non-White women also had lower literacy/numeracy. Although we observed some associations of these factors (but not race/ethnicity) with less receipt of recommended treatments, because few women declined treatments, understanding the scope of impact is limited. However, our results highlight the importance of up-front and longer-term assessments of resource needs and allocation of support for breast cancer survivors. Novelty of this work includes the granular measures on financial distress and the focus on health literacy/numeracy among a diverse population.
Question (N, %) | NH White | NH Black | Hispanic | P-value |
---|---|---|---|---|
Had to borrow money/go into debt | 19 (11) | 13 (17) | 14 (33) | < 0.01 |
Worry about paying large medical bills | 44 (25) | 21 (28) | 21 (49) | 0.01 |
Can pay bills after cutting back / Difficulty paying bills no matter what | 23 (13) | 31 (41) | 16 (39) | < 0.001 |
Difficulty covering share of visits | 11 (6) | 15 (20) | 6 (15) | 0.003 |
Current financial situation worse (vs. at diagnosis) | 30 (17) | 17 (22) | 9 (22) | 0.27 |
Difficulty understanding written information about medical condition | 4 (2) | 5 (7) | 1 (2) | < 0.001 |
Little/no confidence filling out medical forms | 1 (0.6) | 8 (11) | 5 (12) | < 0.01 |
‘Not good at all’ working with fractions | 29 (16) | 22 (29) | 18 (44) | < 0.001 |
‘Not good at all’ determining 25% off shirt | 9 (5) | 13 (17) | 11 (27) | < 0.001 |
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