Disparities in the Financial Burden of Pediatric Cancer: Household
Material Hardship, Financial Toxicity, and Income Loss
Background Based on previous reports of disparities in
financial burden following cancer, this study aims to characterize
mechanisms of disparities experienced by caregivers of children with
cancer, including the impact of work flexibility and social support.
Methods Cross-sectional survey (in English or Spanish) of
caregivers of children with cancer that assessed household material
hardship (HMH), financial toxicity and income change. Results
Of 156 caregivers surveyed, 32% were Hispanic and 32% were low income.
Hispanic caregivers were more likely to report HMH and financial
toxicity compared to non-Hispanic White and Asian (HMH 57% v. 21% v.
19%, p<0.001; financial toxicity 73% v. 52% v. 53%,
p=0.07). Low and middle income caregivers were more likely to experience
HMH and financial toxicity compared to high income (HMH: 68% low v.
38% middle v 8.7% high, p<0.001; financial toxicity: 81% v.
68% v. 44%, p<0.001). All income categories demonstrated
significant increases in HMH one year after diagnosis. Seventeen percent
reported >40% income loss, more of whom were low income
than high income (27% v. 12%, p=0.20). Work flexibility and social
support were associated with income and financial toxicity.
Conclusion HMH, financial toxicity, and income loss are
prevalent after a child’s cancer diagnosis, suggesting that screening
should be incorporated into routine care. This financial burden
disproportionately affects low income and Hispanic caregivers. Further
research is underway to understand how safety net services are utilized
by families, how best to support families with HMH, and how the
financial burden of cancer has been impacted by COVID-19.