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The association of health insurance literacy and numeracy with financial toxicity and hardships among colorectal cancer survivors

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Abstract

Purpose

In this study, we examined the association of financial hardship measured by material financial burden and financial toxicity with health insurance literacy and numeracy among colorectal cancer survivors. The lack of evidence on the impact of cost-related health literacy, specifically health insurance literacy and numeracy, on financial toxicity among cancer survivors warrants further research.

Methods

Between January and November 2019, we used a cross-sectional research design to collect surveys from 104 colorectal cancer survivors (diagnosed within last 5 years) from the Kentucky Cancer Registry. Survey items assessed health insurance literacy (measured by confidence and behaviors in choosing and using health insurance), numeracy, material financial burden, and financial toxicity, in addition to socio-demographic variables. Survey data were subsequently linked to the participant’s cancer registry record. Data were analyzed using descriptive, bivariate, and multiple linear regression analyses.

Results

The mean financial toxicity score was 24.5, with scores ranging from 3 to 43 (higher scores indicating greater financial toxicity). Eighty percent of participants indicated they had experienced one or more material burdens related to their cancer. The majority had adequate health insurance (79%); however, the majority also had low numeracy (84%). After controlling for socio-demographic covariates, significant predictors of greater financial toxicity were high material burden scores, low health insurance literacy, and low numeracy.

Conclusions

Findings indicate the need to develop programs and interventions aimed at improving health insurance literacy and numeracy as a strategy for reducing financial toxicity and hardships among colorectal cancer survivors.

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Data availability

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.

Code availability

Not applicable

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Funding

This study was funded by the American Cancer Society Institutional Research Grant (#IRG 16-182-28).

Author information

Authors and Affiliations

  1. College of Nursing and Markey Cancer Center, University of Kentucky, 751 Rose St., Room 557, Lexington, KY, 40536, USA

    Jean S. Edward & Mary Kay Rayens

  2. Appalachian Career Training in Oncology (ACTION) Program, University of Kentucky, 800 Rose Street, Lexington, KY, 40536, USA

    Xiaomei Zheng

  3. College of Public Health, University of Kentucky, 111 Washington Ave, Lexington, KY, 40536, USA

    Robin C. Vanderpool

Authors
  1. Jean S. Edward
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  4. Robin C. Vanderpool
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Contributions

All authors had full access to the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Conceptualization, JE and RV; methodology, JE, MK, and RV; investigation, JE, XZ, and RV; formal analysis, JE, MK, and RV; resources, JE and RV; writing - original draft, JE, MK, XZ, and RV; writing - review and editing, JE, MK, XZ, and RV; visualization, JE and MK; supervision, RV; and funding acquisition, JE and RV.

Corresponding author

Correspondence to Jean S. Edward.

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Ethics approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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The authors affirm that human subject research participants provided informed consent for publication of their de-identified data.

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The authors declare no competing interests.

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Edward, J.S., Rayens, M.K., Zheng, X. et al. The association of health insurance literacy and numeracy with financial toxicity and hardships among colorectal cancer survivors. Support Care Cancer 29, 5673–5680 (2021). https://doi.org/10.1007/s00520-021-06036-9

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  • DOI: https://doi.org/10.1007/s00520-021-06036-9

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