Top

Journal of Cancer Survivorship

Published in:

03-08-2022 | COVID-19

Social risk factors among individuals with a history of cancer during the COVID-19 pandemic

Authors: Cheryl Kelly, Larissa Lee White, Shauna Goldberg Scott, Heather Spencer Feigelson, Andrea N. Burnett-Hartman

Published in: Journal of Cancer Survivorship | Issue 2/2023

Abstract

Purpose

The coronavirus disease (COVID-19) pandemic and its economic consequences may disproportionately impact cancer survivors and their overall health-related quality of life. The objective of this study was to examine whether cancer survivors experienced higher levels of financial strain or food insecurity compared to those without a history of cancer.

Methods

Kaiser Permanente Research Bank (KPRB) study participants were invited to complete a series of electronic surveys starting April 2020 to assess the impact of the COVID-19 pandemic. Participants who completed the initial survey and one follow-up survey were included. The odds of financial strain and food insecurity in those with and without a history of cancer were estimated using multinomial logistic regression.

Results

Cancer survivors (n = 16,231) had lower odds of reporting “somewhat hard” (AOR = 0.77) and “very hard” (AOR = 0.67) financial strain, and food insecurity “sometimes” (AOR = 0.70) and “often” (AOR = 0.55) compared to those with no history of cancer (n = 88,409). Non-Hispanic (NH) Black and Hispanic cancer survivors had higher odds compared to NH Whites of reporting financial strain and food insecurity. Smokers and those with multiple comorbidities had higher odds of reporting financial strain and food insecurity among cancer survivors.

Conclusions

While cancer survivors overall did not report greater financial strain or food insecurity than individuals without a history of cancer, subsets of cancer survivors are experiencing greater social risks during the pandemic and should be prioritized for screening for social risk factors.

Implications for Cancer Survivors

Incorporating screening for social risk factors into care coordination workflows for subsets of cancer survivors should be a priority.

Available only for authorised users

Hardship is below December 2020 peak, yet still widespread. Accessed January 20, 2022. https://www.cbpp.org/hardship-is-below-december-2020-peak-yet-still-widespread-3.

Baddour K, Kudrick LD, Neopaney A, et al. Potential impact of the COVID-19 pandemic on financial toxicity in cancer survivors. Head Neck. 2020. https://doi.org/10.1002/hed.26187.CrossRefPubMedPubMedCentral

Staying Well During COVID-19. A guide for cancer patients and their caregivers and family members. Accessed June 7, 2022. https://www.cdc.gov/cancer/survivors/staying-well-during-covid-19.htm.

Miller KD, Nogueira L, Mariotto AB, et al. Cancer treatment and survivorship statistics, 2019. CA: Cancer J Clin. 2019;69(5):363–85. https://doi.org/10.3322/caac.21565.CrossRefPubMed

Banegas MP, Guy GP Jr, de Moor JS, et al. For working-age cancer survivors, medical debt and bankruptcy create financial hardships. Policy Anal Brief H Ser. 2016;35(1):54–61. https://doi.org/10.1377/hlthaff.2015.0830.CrossRef

Han X, Zhao J, Zheng Z, de Moor JS, Virgo KS, Yabroff KR. Medical financial hardship intensity and financial sacrifice associated with cancer in the United States. Cancer Epidemiol Biomarkers Prev. 2020;29(2):308–17. https://doi.org/10.1158/1055-9965.Epi-19-0460.CrossRefPubMedPubMedCentral

Yabroff KR, Dowling EC, Guy GP Jr, et al. Financial hardship associated with cancer in the United States: findings from a population-based sample of adult cancer survivors. J Clin Oncol. 2016;34(3):259–67. https://doi.org/10.1200/JCO.2015.62.0468.CrossRefPubMed

Whitney RL, Bell JF, Reed SC, et al. Predictors of financial difficulties and work modifications among cancer survivors in the United States. J Cancer Surviv. 2016;10(2):241–50. https://doi.org/10.1007/s11764-015-0470-y.CrossRefPubMed

Ramsey S, Blough D, Kirchhoff A, et al. Washington State cancer patients found to be at greater risk for bankruptcy than people without a cancer diagnosis. Policy Anal Brief H Ser. 2013;32(6):1143–52. https://doi.org/10.1377/hlthaff.2012.1263.CrossRef

10.

Politi MC, Grant RL, George NP, et al. Improving Cancer Patients’ Insurance Choices (I Can PIC): a randomized trial of a personalized health insurance decision aid. J Oncol. 2020. https://doi.org/10.1634/theoncologist.2019-0703.CrossRef

11.

Kent EE, de Moor JS, Zhao J, Ekwueme DU, Han X, Yabroff KR. Staying at one’s job to maintain employer-based health insurance among cancer survivors and their spouses/partners. JAMA Oncol. 2020;6(6):929–32. https://doi.org/10.1001/jamaoncol.2020.0742.CrossRefPubMedPubMedCentral

12.

Tangka FKL, Subramanian S, Jones M, et al. Insurance coverage, employment status, and financial well-being of young women diagnosed with breast cancer. Cancer Epidemiol Biomarkers Prev. 2020;29(3):616–24. https://doi.org/10.1158/1055-9965.Epi-19-0352.CrossRefPubMedPubMedCentral

13.

Nathan PC, Henderson TO, Kirchhoff AC, Park ER, Yabroff KR. Financial hardship and the economic effect of childhood cancer survivorship. J Clin Oncol. 2018;36(21):2198–205. https://doi.org/10.1200/jco.2017.76.4431.CrossRefPubMed

14.

Altice CK, Banegas MP, Tucker-Seeley RD, Yabroff KR. Financial hardships experienced by cancer survivors: a systematic review. J Natl Cancer Inst. 2017;109(2). https://doi.org/10.1093/jnci/djw205.

15.

Zhao J, Zheng Z, Han X, et al. Cancer history, health insurance coverage, and cost-related medication nonadherence and medication cost-coping strategies in the United States. Value Health. 2019;22(7):762–7. https://doi.org/10.1016/j.jval.2019.01.015.CrossRefPubMed

16.

Ramsey SD, Bansal A, Fedorenko CR, et al. Financial insolvency as a risk factor for early mortality among patients with cancer. J Clin Oncol. 2016;34(9):980–6. https://doi.org/10.1200/JCO.2015.64.6620.CrossRefPubMedPubMedCentral

17.

Bestvina CM, Zullig LL, Rushing C, et al. Patient-oncologist cost communication, financial distress, and medication adherence. J Oncol Pract. 2014;10(3):162–7. https://doi.org/10.1200/jop.2014.001406.CrossRefPubMed

18.

Dusetzina SB, Winn AN, Abel GA, Huskamp HA, Keating NL. Cost sharing and adherence to tyrosine kinase inhibitors for patients with chronic myeloid leukemia. J Clin Oncol. 2014;32(4):306–11. https://doi.org/10.1200/jco.2013.52.9123.CrossRefPubMed

19.

Knight TG, Deal AM, Dusetzina SB, et al. Financial toxicity in adults with cancer: adverse outcomes and noncompliance. J Oncol Pract. 2018;Jop1800120. https://doi.org/10.1200/jop.18.00120.

20.

Tran G, Zafar SY. Financial toxicity and implications for cancer care in the era of molecular and immune therapies. Ann Transl Med. 2018;6(9):166. https://doi.org/10.21037/atm.2018.03.28.CrossRefPubMedPubMedCentral

21.

Trego ML, Baba ZM, DiSantis KI, Longacre ML. Food insecurity among adult cancer survivors in the United States. J Cancer Surviv. 2019;13(4):641–52. https://doi.org/10.1007/s11764-019-00783-9.CrossRefPubMed

22.

Brenner MH. Will there be an epidemic of corollary illnesses linked to a COVID-19-related recession?. Am J Public Health. 2020;e1-e2. https://doi.org/10.2105/ajph.2020.305724.

23.

Nekhlyudov L, Duijts S, Hudson SV, et al. Addressing the needs of cancer survivors during the COVID-19 pandemic. J Cancer Surviv. 2020;1–6. https://doi.org/10.1007/s11764-020-00884-w.

24.

Blustein DL, Duffy R, Ferreira JA, Cohen-Scali V, Cinamon RG, Allan BA. Unemployment in the time of COVID-19: a research agenda. J Vocat Behav. 2020;103436. https://doi.org/10.1016/j.jvb.2020.103436.

25.

Thom B, Benedict C, Friedman DN, Watson SE, Zeitler MS, Chino F. Economic distress, financial toxicity, and medical cost-coping in young adult cancer survivors during the COVID-19 pandemic: findings from an online sample. Cancer. 2021;127(23):4481–91. https://doi.org/10.1002/cncr.33823.CrossRefPubMed

26.

van Egmond MP, Duijts SFA, Loyen A, Vermeulen SJ, van der Beek AJ, Anema JR. Barriers and facilitators for return to work in cancer survivors with job loss experience: a focus group study. Eur J Cancer Care (Engl). 2017;26(5). https://doi.org/10.1111/ecc.12420.

27.

Kvale MN, Hesselson S, Hoffmann TJ, et al. Genotyping informatics and quality control for 100,000 subjects in the Genetic Epidemiology Research on Adult Health and Aging (GERA) cohort. Genetics. 2015;200(4):1051–60. https://doi.org/10.1534/genetics.115.178905.CrossRefPubMedPubMedCentral

28.

Feigelson HSCC, Van Den Eeden SK, et al. The Kaiser Permanente Research Bank Cancer Cohort: a collaborative resource to improve cancer care and survivorship. BMC Cancer. 2022;22(1):209. https://doi.org/10.1186/s12885-022-09252-6.CrossRefPubMedPubMedCentral

29.

Cella D, Riley W, Stone A, et al. The Patient-Reported Outcomes Measurement Information System (PROMIS) developed and tested its first wave of adult self-reported health outcome item banks: 2005–2008. J Clin Epidemiol. 2010;63(11):1179–94. https://doi.org/10.1016/j.jclinepi.2010.04.011.CrossRefPubMedPubMedCentral

30.

Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. J Health Soc Behav. 1983;24(4):385–96.CrossRefPubMed

31.

Williams DR, Yan Y, Jackson JS, Anderson NB. Racial differences in physical and mental health: socio-economic status, stress and discrimination. J Health Psychol. 1997;2(3):335–51. https://doi.org/10.1177/135910539700200305.CrossRefPubMed

32.

Behavioral Risk Factor Surveillance System—survey data & documentation. Accessed November 7, 2021. https://www.cdc.gov/brfss/data_documentation/index.htm.

33.

Kahn JR, Pearlin LI. Financial strain over the life course and health among older adults. J Health Soc Behav. 2006;47(1):17–31. https://doi.org/10.1177/002214650604700102.CrossRefPubMed

34.

Institute of Medicine. Capturing Social and Behavioral Domains and Measures in Electronic Health Records: Phase 2. The National Academies Press; 2014:374.

35.

Hager ER, Quigg AM, Black MM, et al. Development and validity of a 2-item screen to identify families at risk for food insecurity. Pediatrics. 2010;126(1):e26-32. https://doi.org/10.1542/peds.2009-3146.CrossRefPubMed

36.

Hornbrook MC, Hart G, Ellis JL, et al. Building a virtual cancer research organization. J Natl Cancer Inst. 2005;35:12–25. https://doi.org/10.1093/jncimonographs/lgi033.CrossRef

37.

Ross TR, Ng D, Brown JS, et al. The HMO Research Network Virtual Data Warehouse: A Public Data Model to Support Collaboration. EGEMS (Washington, DC). 2014;2(1):1049. https://doi.org/10.13063/2327-9214.1049.CrossRefPubMed

38.

Seiffert JE. Development and use of the North American Association of Central Cancer Registries standards for cancer registries. Top Health Inf Manage. 1997;17(3):35–44.PubMed

39.

Klabunde CN, Potosky AL, Legler JM, Warren JL. Development of a comorbidity index using physician claims data. Validation Studies. J Clin Epidemiol. 2000;53(12):1258–67.CrossRefPubMed

40.

Garg A, Jack B, Zuckerman B. Addressing the social determinants of health within the patient-centered medical home: lessons from pediatrics. JAMA. 2013;309(19):2001–2. https://doi.org/10.1001/jama.2013.1471.CrossRefPubMed

41.

Gottlieb LM, Tirozzi KJ, Manchanda R, Burns AR, Sandel MT. Moving electronic medical records upstream: incorporating social determinants of health. Am J Prev Med. 2015;48(2):215–8. https://doi.org/10.1016/j.amepre.2014.07.009.CrossRefPubMed

42.

Bazemore AW, Cottrell EK, Gold R, et al. “Community vital signs”: incorporating geocoded social determinants into electronic records to promote patient and population health. JAMA. 2016;23(2):407–12. https://doi.org/10.1093/jamia/ocv088.CrossRef

43.

Page-Reeves J, Kaufman W, Bleecker M, et al. Addressing social determinants of health in a clinic setting: the WellRx Pilot in Albuquerque, New Mexico. JABFM. 2016;29(3):414–8. https://doi.org/10.3122/jabfm.2016.03.150272.CrossRefPubMed

44.

Pinto AD, Glattstein-Young G, Mohamed A, Bloch G, Leung FH, Glazier RH. Building a foundation to reduce health inequities: routine collection of sociodemographic data in primary care. JABFM. 2016;29(3):348–55. https://doi.org/10.3122/jabfm.2016.03.150280.CrossRefPubMed

45.

DeVoe JE, Bazemore AW, Cottrell EK, et al. Perspectives in primary care: a conceptual framework and path for integrating social determinants of health into primary care practice. Ann Fam Med. 2016;14(2):104–8. https://doi.org/10.1370/afm.1903.CrossRefPubMedPubMedCentral

46.

Billioux A, Verlander K, Anthony S, Alley D. Standardized screening for health-related social needs in clinical settings: the accountable health communities screening tool. NAM Perspectives. Discussion Paper, National Academy of Medicine, Washington, DC. https://doi.org/10.31478/201705b.

47.

Cottrell EK, Gold R, Likumahuwa S, et al. Using health information technology to bring social determinants of health into primary care: a conceptual framework to guide research. J Health Care Poor Underserved. 2018;29(3):949–63. https://doi.org/10.1353/hpu.2018.0071.CrossRefPubMedPubMedCentral

48.

LaForge K, Gold R, Cottrell E, et al. How 6 organizations developed tools and processes for social determinants of health screening in primary care: an overview. J Ambul Care Manag. 2018;41(1):2–14. https://doi.org/10.1097/jac.0000000000000221.CrossRef

49.

Kreuter MW, Thompson T, McQueen A, Garg R. Addressing social needs in health care settings: evidence, challenges, and opportunities for public health. Annu Rev Public Health. 2021;42:329–44.CrossRefPubMedPubMedCentral

50.

Garg A, Boynton-Jarrett R, Dworkin P. Avoiding the unintended consequences of screening for social determinants of health. JAMA. 2016;316(8):813–4.CrossRefPubMed

Title: Social risk factors among individuals with a history of cancer during the COVID-19 pandemic
Authors: Cheryl Kelly
Larissa Lee White
Shauna Goldberg Scott
Heather Spencer Feigelson
Andrea N. Burnett-Hartman
Publication date: 03-08-2022
Publisher: Springer US
Keyword: COVID-19
Published in: Journal of Cancer Survivorship / Issue 2/2023
Print ISSN: 1932-2259
Electronic ISSN: 1932-2267
DOI: https://doi.org/10.1007/s11764-022-01235-7

Webinar | 19-02-2024 | 17:30 (CET)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer

Watch now

Antibody–drug conjugates (ADCs) are novel agents that have shown promise across multiple tumor types. Explore the current landscape of ADCs in breast and lung cancer with our experts, and gain insights into the mechanism of action, key clinical trials data, existing challenges, and future directions.

Dr. Véronique Diéras

Prof. Fabrice Barlesi

Developed by: Springer Medicine

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Implications for Cancer Survivors

Please log in to get access to this content

Other articles of this Issue 2/2023

Experiences of adolescent and young adult cancer survivors during the COVID-19 pandemic

Trajectories of cognitive symptoms and associated factors in cancer survivors after return to work: an 18-month longitudinal cohort study

Chronic pain and its correlates among long-term breast cancer survivors

Return to work in head and neck cancer survivors: a systematic review

Health-related quality of life in adolescents and young adults with and without cancer, using propensity score matching

Cardiovascular disease prevention and management of pre-existent cardiovascular disease in a cohort of prostate cancer survivors

Keynote webinar | Spotlight on antibody–drug conjugates in cancer