Financial hardship, financial toxicity, and transportation challenges among older cancer survivors treated with curative-intent surgery.

PURPOSE: Financial hardship (FH) and financial toxicity (FT) are associated with worse outcomes among cancer patients, and older adults experiencing transportation issues are more likely to miss follow-up care and delay care for chronic conditions during survivorship. Older adults are often eligible for federal benefits such as Medicare and Social Security, and resultantly FH, FT, and transportation issues are understudied among older adults during survivorship.

METHODS

We surveyed individuals diagnosed at ≥ 50 years with breast, colorectal, prostate, and lung cancers who received curative-intent surgery at our institution from 2000 to 2019. Demographic and clinic data were collected from survey responses and medical records. FH, FT, and transportation issues were evaluated using validated questions. Multivariable regression models were used to evaluate factors associated with FH, FT, and transportation challenges.

RESULTS

Respondents (n = 615) experiencing FH were younger (p < 0.0001), non-White (43% vs 22%, p < 0.0001), low-income (40% vs 16%, p < 0.0001), and faced transportation barriers (22% vs 6%, p < 0.0001). Up to 39% of patients without FH reported FT. In multivariable models, age < 65, low income, more recent diagnosis, and transportation issues were associated with both FH and FT. Non-White patients had higher odds of experiencing transportation issues (OR 3.2, 95% CI 1.7-6.0).

CONCLUSIONS

Older survivors who underwent surgery faced significant financial hardship, financial toxicity, and transportation issues when accessing care. While FH questions measure material and behavioral financial burdens, FT questions focus more on the psychological burden of financing care. Post-treatment, cancer survivors should be screened for FH, FT, and transportation challenges.