ASPO Abstracts
Financial Hardship Reported by Rural and Urban Cancer Survivors in Wisconsin
Category: Financial Hardship Associated with Cancer
Conference Year: 2020
Abstract Body:
Background: Financial toxicity is increasingly recognized as a common consequence of a cancer diagnosis. We
aimed to measure the prevalence of financial hardship among cancer survivors in Wisconsin and to examine
whether frequency varied between rural and urban residents.
Methods: Participants in the Survey of the Health of Wisconsin (SHOW), a comprehensive ongoing annual health
survey gathering data on health and a wide range of health determinants across the state of Wisconsin, who
previously reported a cancer diagnosis received a mailed survey with questions regarding their cancer experience
including the Comprehensive Score for financial Toxicity (COST) measure. Following the recommended scoring
approach, COST measures were calculated from 11 questions, with lower scores reflecting greater financial
hardship. RUCA codes were used to define urban and rural residence.
Results: A total of 486 cancer survivors were approached in October 2019 to complete the cancer survivorship
survey; as of 11/1/2019, 176 (36%) have been completed. Survivors were mostly white (94%) and aged ≥60
(80%); 52% were female, 56% resided in urban areas, and were frequently insured (52% Medicare or 35%
HMO/private). Overall, the mean (± standard deviation) COST scores for survivors was 33.0 (±7.9) with minimum
10 and maximum 44. COST scores were similar according to sex and urban/rural residence but reflected greater
hardship for non-white (30.8±5.5) compared with white (33.1±8.0) survivors, and younger (<60: 28.4±8.5)
compared with older survivors (70+: 34.3±6.6). Survivors with no insurance (16.0±4.2), marketplace (25.4±9.8),
and Medicaid (27.7±6.2) reflected greater hardship compared with survivors with HMO/private (32.6±7.9) or
Medicaid insurance (34.3±7.3). Rural survivors were more likely than urban residents to borrow money or go into
debt for cancer treatment (8.7% vs. 4.9%). On-going data collection will be completed by January 2020.
Conclusions: Preliminary results suggest that, even in this highly insured sample, financial hardship is common
and more frequently affects younger, rural, and racial minority survivors.
Keywords: Financial Toxicity, survivorship, rural residence, health insurance