Impact of the COVID-19 Pandemic on Financial Burden in Those with a Recent History of Cancer

Abstract

Cancer is well known to create significant financial burden on patients. The pandemic posed novel financial challenges, potentially worsening financial burden. We hypothesized that the financial burden experienced by participants with a recent history of cancer (HC) during the pandemic would be increased compared to participants without history of cancer (NC). From June-November 2020, individuals who participated in past Ohio State University (OSU) studies, cancer patients, their caregivers and individuals on OSU community partner listservs were asked to participate in a survey to assess the pandemic's impact on employment and financial concerns (FC). Responses were compiled in a FC score. We wanted to evaluate the impact of a recent cancer diagnosis and treatment, so HC was defined as being diagnosed with cancer within 3 years prior to the survey date. Participants who worked prior to COVID, were matched by propensity score using a 1:2 algorithm to best compare financial burden across HC and NC. Negative binomial multivariable analysis (MVA) was used to compare FC scores of HC to NC, with adjustment for demographic and socioeconomic characteristics. The interaction between HC vs NC and race was examined in MVA. Of 32,989 contacted individuals, 9,423 (26.8%) completed the survey. Those with a cancer diagnosis >3 years ago, and/or no full-time employment prior to the pandemic were excluded, leaving a sample of 2,703 participants (449 HC and 2,254 NC). The median age was 54 years for HC and 50 years for NC, 83.7% of HC and 80.0% NC had private insurance, and 4.5% of HC and 6.1% of NC had public insurance, 61.7% of HC and 60.2% of NC had income of $75k+ and 6.0% of HC and 7.2% of NC had income of <35k, 5.8% of HC and 5.2% of NC were Black (p<0.01 for all). Given significant differences in baseline characteristics of both groups, a matched pair-analysis of 1218 participants (421 HC and 797 NC) was performed and utilized for remaining analyses. There were no differences between HC and NC in being paid for a full or part-time job (p = 0.15) or job loss (p = 0.47), due to the pandemic. On MVA, HC were less likely to have financial concerns than NC. Black participants had a 1.55 times higher FC score than white participants, and those with an annual household income < $35K and $35K-50K had 1.8 and 1.5 times higher FC score compared to those with income of $75K or higher (p<0.01 for all). When Black HC were compared to Black NC, HC had 1.6 times higher odds of financial concerns (p = 0.02). In this selected population, HC were less likely to have financial concerns than NC, potentially due to difference in baseline characteristics that could not be accounted for in MVA. However, those with total income <$50k and Black participants, particularly Black HC, were the groups most likely to have FC during the pandemic. Further analysis should investigate long-term ramifications of increased FC in these vulnerable groups, particularly when pandemic and cancer-related financial burdens are compounded.