Financial Impact of Breast Cancer in Black Versus White Women
Menée aux Etats-Unis à partir de données portant sur 2 494 patientes atteintes d'un cancer du sein diagnostiqué entre 2008 et 2013, cette étude de cohorte prospective analyse, chez les femmes blanches et chez les femmes noires, les effets de la maladie sur leurs finances personnelles
Purpose : Racial variation in the financial impact of cancer may contribute to observed differences in the use of guideline-recommended treatments. We describe racial differences with regard to the financial impact of breast cancer in a large population-based prospective cohort study. Methods : The Carolina Breast Cancer Study oversampled black women and women younger than age 50 years with incident breast cancer in North Carolina from 2008 to 2013. Participants provided medical records and data regarding demographics, socioeconomic status, and financial impact of cancer at 5 and 25 months postdiagnosis. We report unadjusted and adjusted financial impact at 25 months postdiagnosis by race. Results : The sample included 2,494 women who completed follow-up surveys (49% black, 51% white). Since diagnosis, 58% of black women reported any adverse financial impact of cancer (v 39% of white women; P < .001). In models adjusted for age, stage at diagnosis, and treatment received, black women were more likely to report adverse financial impact attributable to cancer (adjusted risk difference [aRD], +14 percentage points; P < .001), including income loss (aRD, +10 percentage points; P < .001), health care–related financial barriers (aRD, +10 percentage points; P < .001), health care–related transportation barriers (aRD, +10 percentage points; P < .001), job loss (aRD, 6 percentage points; P < .001), and loss of health insurance (aRD, +3 percentage points; P < .001). The effect of race was attenuated when socioeconomic factors were included but remained significant for job loss, transportation barriers, income loss, and overall financial impact. Conclusion : Compared with white women, black women with breast cancer experience a significantly worse financial impact. Disproportionate financial strain may contribute to higher stress, lower treatment compliance, and worse outcomes by race. Policies that help to limit the effect of cancer-related financial strain are needed.