The Impact of Receiving Radiation Treatment on Financial Toxicity in Underserved Hispanic Cancer Patients with Limited English Proficiency

Abstract

<h3>Purpose/Objective(s)</h3> Racial and ethnic minority cancer patients in the US are at high risk for financial toxicity (FT). Prior FT outcomes for Hispanic cancer patients is mixed, though risk factors including socioeconomic, insurance, and English language proficiency barriers may influence FT outcomes in this population, though available data are lacking for US Hispanic cancer patients with un/under-insurance and low English proficiency. Therefore, we examined factors associated with FT in Hispanic cancer patients treated with or without RT. We hypothesized that un/under-insured and Spanish-only speaking Hispanic cancer patients would have more severe FT and receipt of RT would increase FT. <h3>Materials/Methods</h3> We conducted a multi-institution survey of Hispanic cancer patients receiving ambulatory oncology care. Depending on reported language preference, respondents underwent a Spanish- or English-language version of the Economic Strain and Resilience in Cancer (ENRICh) FT measure. Respondents were categorized in 3 groups: 1) un/under-insured Spanish-only speaking Hispanics (UN-Spanish) recruited from a public hospital for medically underserved patients 2) un/under-insured English-speaking Hispanics (UN-English, n=23) from the same facility and 3) insured English-speaking Hispanics (INS-English, n=31) from an academic comprehensive cancer center. Any receipt of RT, either pre- or post-survey, was recorded. Groups were compared via Fisher exact or Mann-Whitney U tests. <h3>Results</h3> A higher likelihood of severe overall FT occurred in UN-Spanish (OR=2.73, 95% CI 0.77-9.70; borderline P=0.12) and UN-English (OR=4.13, 95% CI 1.13-15.12; P=0.03) vs. INS-English Hispanics. However, the likelihood of FT did not differ between UN-Spanish and UN-English Hispanics in both models (P=0.59 and P=0.62 respectively). UN-Spanish Hispanics frequently identified completely lacking credit, savings, or income and food insecurity as key aspects of FT. Of 77 patients, 47 (61.0%) received RT as part of their cancer treatment. UN-Spanish (9/23, 39.1%) and UN-English (13/23, 56.5%) respondents were less likely to receive radiation as part of their treatment when compared to INS-English patients (25/31, 80.7%; p = 0.007). Respondents who received radiation treatment had similar overall FT score (median 3.8) when compared to those who had not (median 5.55; p = 0.214). Respondents who had already received RT demonstrated similar overall FT score (median 3.27) when compared with those who went on to receive RT (median 4.87; p = 0.559). <h3>Conclusion</h3> In this pilot study focused on medically underserved, un/under-insured Hispanics with cancer, inadequate insurance was a key predictor of FT regardless of language. Receipt of RT did not appear to impact overall FT. However, un- and under-insured Hispanic cancer patients were less likely to receive radiation as part of their treatment course, which may reflect a disparity in access to care based on insurance status.