1. Theresa Hastert, Ph.D. WHI Cancer SIG Call September 19th, 2016
Predictors of Financial Burden in Cancer Survivors: Results from the LILAC Study
Theresa Hastert, Ph.D.
WHI Cancer SIG Call
September 19th, 2016

2. Co-Authors and Collaborators
Electra Paskett (Collaborating LILAC PI)
Cecelia DeGraffinreid
Michelle Naughton
Tasleem Padamsee
Michael Pennell
Michael Simon
Gregory Young
Yousuf Zafar

3. Background
Many cancer survivors face serious financial burdens related to cancer diagnosis, treatment, recovery
10-66% depending on population, measures used
Lifestyle changes, assets/savings, debt, bankruptcy
Financial concerns can impact treatment decisions, future financial health, quality of life, mortality

4. Objectives
Estimate prevalence of cancer-related financial burden among LILAC participants
Examine associations between demographic, cancer, and treatment-related variables and comorbid conditions and financial burden

5. Study Population
LILAC participants who completed both Form F340 (baseline) and F370 (follow-up—including financial burden questions)
7,776 completed F340
Excluded 2,193 who did not complete F370
Excluded 48 missing all financial burden questions
Excluded 4 in situ melanoma (late add to F340)
Total N=5,531

6. LILAC Financial Burden Questions

7. Prevalence of Financial Burden
Type of Burden N %
Denied health insurance 37
0.7
Denied life insurance 85
1.5
Insurance company refused medical insurance claim
145
2.6
Cancer treatment left large debts/bills to pay 83
Trouble getting a mortgage or other loans 7
0.1
Had to get legal assistance to deal with problems related to cancer 16
0.3
Had to declare bankruptcy because of cancer 12
0.2
In general, I do not have enough money to pay for basics (food, housing, etc.)
504
9.1
Any financial burden
801
14.5
Total N=5,531

8. Demographic Characteristics
Financial Burden by Age and Race
Demographic Characteristics
No Burden
N (%)
Any Burden
OR (95% CI) P
Age at diagnosis
<50-59
451 (80.7)
108 (19.3)
1.00
<0.001
60-69
1,947 (84.7)
353 (15.3)
0.76 (0.60, 0.96)
70-79+
2,332 (87.3)
340 (12.7)
0.61 (0.48, 0.77)
Race
Black/African-American
170 (76.2)
53 (23.8)
Non-Hispanic White
4,334 (85.8)
717 (14.2)
0.53 (0.39, 0.73)
Other/multiple
217 (87.5)
31 (12.5)
0.46 (0.28, 0.75)

9. Socioeconomic Characteristics
Financial Burden by Education and Income
Socioeconomic Characteristics
No Burden
N (%)
Any Burden
OR (95% CI) P
Education
≤ High school
682 (85.8)
113 (14.2)
1.00
0.21
Some college
1,531 (84.1)
289 (15.9)
1.14 (0.90, 1.44)
College grad
1,373 (85.9)
226 (14.1)
0.99 (0.78, 1.27)
Grad school
1,114 (86.7)
171 (13.3)
0.93 (0.72, 1.20)
Income
<$20,000
315 (78.0)
89 (22.0)
<0.001
$20,000-34,999
898 (86.5)
140 (13.5)
0.55 (0.41, 0.74)
$35,000-49,999
933 (86.6)
144 (13.4)
0.55 (0.41, 0.73)
$50,000-75,000
1,107 (85.6)
186 (14.4)
0.59 (0.45, 0.79)
$75,000+
1,248 (86.4)
197 (13.6)
0.56 (0.42, 0.74)

10. Financial Burden by Cancer Site
No Burden
N (%)
Any Burden
OR (95% CI) P
Breast
2,853 (85.6)
478 (14.4)
1.00
0.59
Ovary
99 (83.2)
20 (16.8)
1.21 (0.74, 1.97)
Endometrial
423 (85.5)
72 (14.5)
1.02 (0.78, 1.33)
Colorectal
492 (86.5)
77 (13.5)
0.93 (0.72, 1.21)
Lung
200 (82.3)
43 (17.7)
1.28 (0.91, 1.81)
Melanoma
287 (83.4)
57 (16.6)
1.19 (0.88, 1.60)
Non-Hodgkin’s Lymphoma
279 (87.7)
39 (12.3)
0.83 (0.59, 1.18)
Leukemia
15 (13.4)
0.92 (0.53, 1.60)

11. Financial Burden by Cancer Stage, Treatment
Site, Treatment
Categories
No Burden
N (%)
Any Burden
OR (95% CI) P
Stage
Localized
3,396 (85.9)
557 (14.1)
1.00
0.14
Regional
949 (83.6)
186 (16.4)
1.19 (1.00, 1.43)
Distant
307 (86.2)
49 (13.8)
0.97 (0.71, 1.33)
Chemotherapy No
3,321 (86.3)
529 (13.7)
0.01
Yes
1,382 (83.6)
271 (16.4)
1.23 (1.05, 1.44)
Radiation
2,384 (85.4)
408 (14.6)
0.83
2,311 (85.6)
389 (14.4)
0.98 (0.85, 1.14)
Hormone therapy
2,754 (85.3)
475 (14.7)
0.72
1,943 (85.6)
326 (14.4)
0.97 (0.84, 1.13)

12. Summary
Overall prevalence of financial burden low using LILAC measures
Not having enough to cover the basics most common
Younger age, African-American race, low income, chemotherapy associated with financial burden

13. Strengths & Limitations
Large cohort of survivors from across U.S.
Several cancers
Cancer, treatment information
Limitations
Limited financial burden measures, power
May not represent important patient experiences
May not be cancer-specific
Timing, survival bias
74% 5+ yrs. since dx; issues may be resolved

14. Next Steps Comorbidity index in LILAC
Consider several factors for adjusted analyses
Demographics (age, race, marital status)
Socioeconomic characteristics (income, education)
Insurance at diagnosis
Comorbidities
Cancer, stage, treatment

15. Comments/Questions?
Thank you.