Financial hardship and mental health among cancer survivors: examining the moderating role of race/ethnicity.

PURPOSE: This study examines how the relationship between financial hardship and mental health concerns among cancer survivors differs across racial/ethnic groups.

METHODS

Using data from 10,248 cancer survivors aged 18 + from the 2021-2023 National Health Interview Survey, we conducted multiple logistic regression analyses to examine the association between the number of financial hardship domains and mental health concerns, while controlling for sociodemographic (age, sex, marital status, race/ethnicity), economic (insurance status, education, family income), and health-related factors (age at diagnosis, number of comorbid conditions). We further tested interactions between race/ethnicity and financial hardship domains on both multiplicative and additive scales, applying Benjamini-Hochberg false discovery rate correction for multiple comparisons.

RESULTS

Hispanic and non-Hispanic Black survivors reported higher rates of each hardship domain compared to non-Hispanic White survivors, and mental health concerns were lowest among non-Hispanic Black survivors. Across all racial/ethnic groups, all three financial hardship domains independently predicted mental health concerns, with behavioral hardship showing the strongest association. The interaction between psychological hardship and non-Hispanic Black race was significant prior to correction for multiple comparisons (OR = 1.99, 95% CI = 1.13-3.50, p = 0.017); however, this interaction did not remain significant after FDR correction (adjusted p = 0.252) or on the additive scale (RERI = 0.143, 95% CI =  - 0.451 to 0.737, p = 0.637). No other interactions were significant.

CONCLUSIONS

Financial hardship is strongly associated with mental health concerns among cancer survivors across all racial and ethnic groups. Exploratory analyses suggested a potentially stronger association between psychological financial hardship and mental health among non-Hispanic Black compared to non-Hispanic White survivors, but this finding requires replication in larger, more diverse samples.

IMPLICATIONS FOR CANCER SURVIVORS: This study shows that addressing financial hardship among the growing number of cancer survivors could be a critical mental health intervention across all communities, and a targeted approach could advance public health.