Native Hawaiian and Pacific Islander Cancer Survivors Face More Significant Medical Financial Hardship

A new study assessed how medical financial hardship affects Native Hawaiian and Pacific Islander (NHPI) cancer survivors.

“Although medical financial hardship (MFH) resulting from sequelae of cancer and treatment has been reported in other racial/ethnic populations, little is known about MFH among Native Hawaiian and Pacific Islander (NHPI) cancer survivors,” the study authors wrote.

The 2014 NHPI National Health Interview Survey (NHIS) was used to identify 150 adult NPHI cancer survivors, which was defined as those with a history cancer not including nonmelanoma/unknown type of skin cancer. Three domains were used to defined medical financial hardship:

1. material (problem paying or unable to pay medical bills)
2. psychological (worrying about paying medical bills)
3. behavioral (delaying or forgoing medical care for financial reasons)

Identified NHPI patients were compared to 2,098 non-Hispanic white cancer survivors located using the 2014 NHIS. The study authors employed logistic regressions to determine which sociodemographic and health factors were most correlated with medical financial hardship. Analyses were conducted by age: <65 years vs. ≥65 years. Sensitivity analysis was performed with propensity score-matched NHPI and non-Hispanic white cancer survivors.

In the older group, NHPIs were more likely that non-Hispanic white survivors to report any medical financial hardship (59% vs. 32%; P=0.001), psychological medical financial hardship (36% vs. 22%; P=0.040), and behavioral medical financial hardship (27% vs. 9%; P=0.004). In the younger survivor analyses, the rate of medical financial hardship was lower among NHPIs (46% vs. 65%, respectively; P=0.034). Similar outcomes were observed in propensity score-matched analyses. Risk factors for any medical financial hardship and psychological medical financial hardship among NHPIs were female sex and having a college degree.

The study was published in Cancer.

“A significantly higher proportion of elderly NHPI cancer survivors reported MFH, and this difference persisted even after propensity score matching, which warrants further investigation,” the study authors summarized.