Evidence map›Paper›PMID 39745895›Full record

ArticleJournal of the National Cancer Institute2025

An intersectional analysis of behavioral financial hardship and healthcare utilization among lesbian, gay, bisexual, transgender, queer, plus cancer survivors.

Austin R Waters, Stephanie B Wheeler, Jeremey Fine, Christabel K Cheung, Kelly R Tan, Donald L Rosenstein, Mya L Roberson, Erin E Kent

Erratum issuedAbstract read
In one paragraph

Article in Journal of the National Cancer Institute, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed.

  1. Article
  2. "Cancer control : journal of the Moffitt Cancer Center
    Article
  3. Review
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

8 authors.

Austin R WatersDepartment of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.ORCID 0000-0002-9947-8535
Stephanie B WheelerDepartment of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.ORCID 0000-0002-3399-9047
Jeremey FineDepartment of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.ORCID 0000-0002-1055-3026
Christabel K CheungSchool of Social Work, University of Maryland, Baltimore, MD, United States.ORCID 0000-0003-0721-7053
Kelly R TanDepartment of Health and Community Systems, School of Nursing, University of Pittsburgh, Pittsburgh, PA, United States.ORCID 0000-0003-4289-3188
Donald L RosensteinLineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.ORCID 0000-0002-8611-8012
Mya L RobersonDepartment of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.ORCID 0000-0002-9908-910X
Erin E KentDepartment of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.ORCID 0000-0003-2503-2191

Funding

UNIVERSITY OF MARYLAND GREENEBAUM CANCER CENTERSUPPORT GRANTP30CA134274 · NCI · UNIVERSITY OF MARYLAND BALTIMORE · PI FEYRUZ VIRGILIA RASSOOL · 2008 to 2026
$51.0M
Cancer Care Quality Training ProgramT32CA116339 · NCI · UNIV OF NORTH CAROLINA CHAPEL HILL · PI ETHAN M. BASCH, Stephanie Brooke Wheeler · 2018 to 2026
$3.0M
AHRQ HHS R36 HS030175AHRQ HHS R36HS030175Lineberger Comprehensive Cancer CenterNational Cancer Institute Cancer Center CCSG, P30 CA134274National Institutes and the Agency for Healthcare Research and QualityNational Research ServiceNCI NIH HHS P30 CA134274NCI NIH HHS T32 CA116339
6 · The paper itself

Abstract

backgroundLesbian, gay, bisexual, transgender, queer, or another nonheterosexual or cisgender identity (LGBTQ+) cancer survivors experience high financial hardship. However, structural drivers of inequities do not impact all LGBTQ+ individuals equally. Using All of Us data, we conducted an intersectional analysis of behavioral financial hardship among LGBTQ+ cancer survivors.

methodsLGBTQ+ inequities in behavioral financial hardship (ie, cost-related foregone care, delayed care, and medication alterations) and non-cost-related delayed care were estimated using All of Us data. Multivariable logit models were used to generate predicted probabilities, average marginal effects, and 95% confidence intervals. Models were then used to estimate inequities when disaggregating LGBTQ+ status and combing LGBTQ+ status with age, race, ethnicity, and treatment status.

resultsThis analysis included N = 36 217 cancer survivors (6.6%, n = 2399 LGBTQ+). In multivariable models, LGBTQ+ identity was associated with higher probabilities of and significant average marginal effects for all types of behavioral financial hardship (foregone care 31.1% vs 19.4%; delayed care 22.6% vs 15.6%; medication alterations 19.2% vs 11.9%) and non-cost delayed care (14.3% vs 7.2%). Within the disaggregated analysis, cisgender bisexual and another/multiple orientation women and gender minority survivors had the highest predicted probabilities of all outcomes. In intersectional analyses, survivors who were aged 18-39 and LGBTQ+, Black and LGBTQ+, or Hispanic/Latine and LGBTQ+ had the highest predicted probabilities of all outcomes.

conclusionsLGBTQ+ cancer survivors experience significantly more behavioral financial hardship and non-cost-related delayed care than non-LGBTQ+ cancer survivors. Interventions at the individual, system, and policy level are needed to address LGBTQ+ inequities in financial hardship.

Indexed as

Cancer SurvivorsFinancial StressNeoplasmsPatient Acceptance of Health CareSexual and Gender MinoritiesAdultAgedFemaleHealthcare DisparitiesHumansMaleMiddle AgedUnited StatesYoung Adult

Identifiers

PMID39745895
PMCPMC12058255

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.