Financial Hardship & Neighborhood Socioeconomic Disadvantage in Long-term Childhood Cancer Survivors

Alex J Fauer; Weiyu Qiu; I-Chan Huang; Patricia A Ganz; Jacqueline N Casillas; K Robin Yabroff; Gregory T Armstrong; Wendy Leisenring; Rebecca Howell; Carrie R Howell; Anne C Kirchhoff; Yutaka Yasui; Paul C Nathan

doi:10.1093/jncics/pkae033

Financial Hardship & Neighborhood Socioeconomic Disadvantage in Long-term Childhood Cancer Survivors

JNCI Cancer Spectr. 2024 Apr 27:pkae033. doi: 10.1093/jncics/pkae033. Online ahead of print.

Authors

Alex J Fauer^{1

2}, Weiyu Qiu³, I-Chan Huang⁴, Patricia A Ganz^{5

6

7}, Jacqueline N Casillas^{5

6}, K Robin Yabroff⁸, Gregory T Armstrong⁴, Wendy Leisenring⁹, Rebecca Howell¹⁰, Carrie R Howell¹¹, Anne C Kirchhoff¹², Yutaka Yasui⁴, Paul C Nathan¹³

Affiliations

¹ Family Caregiving Institute, Betty Irene Moore School of Nursing.
² Comprehensive Cancer Center, University of California, Davis, Sacramento, CA, USA.
³ University of Alberta; University of Alberta, School of Public Health, Edmonton, Alberta, Canada.
⁴ St Jude Children's Research Hospital, Department of Epidemiology and Cancer Control, Memphis, TN, USA.
⁵ David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA.
⁶ Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles, CA, USA.
⁷ Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, USA.
⁸ Surveillance and Health Equity Science Department, American Cancer Society, Atlanta, GA, USA.
⁹ Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
¹⁰ Department of Radiation Physics, Division of Radiation Oncology, MD Anderson Cancer Center, The University of Texas, Houston, TX, USA.
¹¹ Nutrition Obesity Research Center, Department of Medicine, Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
¹² Cancer Control and Population Sciences, Huntsman Cancer Institute, University of Utah, and University of Utah Department of Pediatrics, Salt Lake City, UT, USA.
¹³ The Hospital for Sick Children, Division of Hematology/Oncology, The University of Toronto, Toronto, Ontario, Canada.

PMID: 38676662
DOI: 10.1093/jncics/pkae033

Abstract

Background: Long-term survivors of childhood cancer face elevated risk for financial hardship. We evaluate whether childhood cancer survivors live in areas of greater deprivation and the association with self-reported financial hardships.

Methods: Cross-sectional analysis of data from the Childhood Cancer Survivor Study (CCSS) between 1970 and 1999, and self-reported financial information from 2017-2019. We measured neighborhood deprivation with the Area Deprivation Index (ADI) based on current zip code. Financial hardship was measured with validated surveys that captured behavioral, material/financial sacrifice, and psychological hardship. Bivariate analyses described neighborhood differences between survivors and siblings. Generalized linear models estimated effect sizes between ADI and financial hardship adjusting for clinical factors and personal socioeconomic status.

Results: Analysis was restricted to 3,475 long-term childhood cancer survivors and 923 sibling controls. Median ages at time of evaluation was 39 [IQR 33,46] and 47 [39,59] years, respectively. Survivors resided in areas with greater deprivation (ADI ≥ 50: 38.7% survivors vs 31.8% siblings, P < .001). One quintile increases in deprivation were associated with small increases in behavioral (2nd quintile P = .017) and psychological financial hardship (2nd quintile P = .009; 3rd quintile, P = .014). Lower psychological financial hardship was associated with individual factors including greater household income ($60,000+ income, P < .001) and being single (P = .048).

Conclusions and relevance: Childhood cancer survivors were more likely to live in areas with socioeconomic deprivation. Both neighborhood level disadvantage and personal socioeconomic circumstances should be evaluated when trying to assist childhood cancer survivors with financial hardships.

Abstract

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