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Racial differences in employment and cost-management behaviors in patients with metastatic breast cancer

  • Epidemiology
  • Published:
Breast Cancer Research and Treatment Aims and scope Submit manuscript

Abstract

Purpose

Little is known about racial variations in the financial impact of cancer care. Using data from a national survey of racially diverse patients with metastatic breast cancer, we examined racial/ethnic patterns in employment and cost-management (i.e., financial coping) behaviors.

Methods

We conducted an online survey of patients with metastatic breast cancer. Participants reported on socio-demographic characteristics, employment, and financial coping behaviors. We employed adjusted modified Poisson regressions to evaluate racial/ethnic differences in changes in work for pay and financial coping.

Results

Our analysis included 1052 respondents from 41 states, including Non-Hispanic Blacks (NHB, 9%), Hispanics (7%), Asians/Pacific Islanders/Native Hawaiians (API/NH, 10%), American Indians/Alaskan Natives (AI/AN, 8%), and Non-Hispanic Whites (NHW, 66%). In adjusted analyses comparing NHWs with patients of color, patients of color were more likely to take unpaid leave (NHB Adjusted Risk Ratio [ARR] = 2.27; 95% CI 1.54, 3.34), take paid leave (Hispanic ARR = 2.27; 95% CI 1.54, 1.29), stop work (AI/AN ARR = 1.22; 95% CI 1.05, 1.41), and reduce work hours (AI/AN ARR = 1.33; 95% CI 1.14, 1.57). Patients of color were more likely than NHWs to stop treatment (NHB ARR = 1.22; 95% CI 1.08, 1.39), borrow money from friends/family (Hispanic ARR = 1.75; 95% CI 1.25, 2.44), skip other medical bills (API/NH ARR = 2.02; 95% CI 1.54, 2.63), and skip non-medical bills (AI/AN ARR = 1.67 95% CI 1.06, 2.63). Non-Hispanic Whites more commonly reported using savings or skipping a vacation to help manage costs.

Conclusions

Racial/ethnic differences exist in employment changes and financial coping among metastatic breast cancer patients, with patients of color experiencing worse consequences. Equity must be a guiding principle in strategies addressing financial burden during cancer care.

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Funding

This work was supported by the National Comprehensive Cancer Network and Pfizer Independent Grants for Learning & Change (no grant number); and the National Cancer Institute (1 K01CA218473-01A1 to C.A.S).

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Authors and Affiliations

  1. Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA

    Cleo A. Samuel, Jennifer C. Spencer & Stephanie B. Wheeler

  2. Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA

    Cleo A. Samuel, Donald L. Rosenstein, Katherine E. Reeder-Hayes, Michelle L. Manning, Jean B. Sellers & Stephanie B. Wheeler

Authors
  1. Cleo A. Samuel
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  2. Jennifer C. Spencer
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  3. Donald L. Rosenstein
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  4. Katherine E. Reeder-Hayes
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  5. Michelle L. Manning
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  6. Jean B. Sellers
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  7. Stephanie B. Wheeler
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Contributions

Conceptualization: CAS, DLR, KERH, MLM, JBS, SBW. Data Curation: CAS, JCS. Formal analysis: JCS. Methodology: CAS, JCS. Visualization: JCS. Project administration: MLM. Writing review and editing: CAS, JCS, DLR, KERH, MLM, JBS, SBW. Final approval of manuscript: CAS, JCS. Financial acquisition: DLR, SBW

Corresponding author

Correspondence to Cleo A. Samuel.

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Conflict of interest

Ms. Sellers reports payment as a consultant with Pfizer which was unrelated to the submitted work. None of the other study authors have any conflicts of interest to disclose, beyond receiving independent grant funding from Pfizer.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The experiments conducted in this study comply with the current laws of the country in which they were performed.

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Informed consent was obtained from all individual participants included in the study.

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Samuel, C.A., Spencer, J.C., Rosenstein, D.L. et al. Racial differences in employment and cost-management behaviors in patients with metastatic breast cancer. Breast Cancer Res Treat 179, 207–215 (2020). https://doi.org/10.1007/s10549-019-05449-9

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  • DOI: https://doi.org/10.1007/s10549-019-05449-9

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