Distinct financial and social hardships among gastrointestinal cancer survivors: a national survey analysis.

backgroundHigh and persistent costs of cancer care often burden survivors, leading to medical financial hardship and, in turn, unmet health‑related social needs (HRSNs) that may hinder treatment adherence and quality-of-life. Gastrointestinal (GI) cancers, often linked with high symptom burden and intensive therapies, may disproportionately aggravate such hardships. We sought to assess medical financial hardship, HRSNs and the interplay of these factors among cancer survivors compared with the general US population.

methodsThe National Health Interview Survey (2013-2018) was used to identify adults (≥ 18 years) categorized as GI cancer survivors, non‑GI cancer survivors, and cancer‑free controls. Medical financial hardship was defined as difficulty paying medical bills, cost-related worry, or delayed/forgone care. HRSNs included food insecurity, housing insecurity and transportation barriers. Survey‑weighted logistic regression was utilized to estimate adjusted prevalences and odds ratios (ORs).

resultsAmong 190,113 adults, 1,722 (0.9%) were GI and 12,264 (6.5%) were non‑GI cancer survivors. Cancer survivors were more likely to have household income ≤ 138% of the poverty guideline (GI: 21.1%; non-GI: 16.7%; controls: 19.9%) and less likely to be uninsured (GI: 4.5%; non-GI: 5.6%; controls: 13.6%) than the general population (both p < 0.001). Among cancer survivors with medical financial hardship, the adjusted prevalence of food insecurity (18.7% vs. 15.6%), housing insecurity (36.7% vs. 33.5%), any HRSN (43.7% vs. 39.5%) and multiple HRSNs (13.6% vs. 11.9%) were higher among GI versus non-GI cancer survivors (all p < 0.001). GI cancer survivors with financial hardship were more likely to experience food (21.0% vs. 4.8%), housing (35.6% vs. 11.7%) and transportation insecurity (5.0% vs. 1.9%) (all p < 0.05). GI cancer survivors had higher odds of food (aOR 1.69, 95%CI 1.31-2.20) and housing insecurity (aOR 1.35, 95% CI 1.10-1.66), as well as multiple HRSNs (aOR 1.80, 95%CI 1.36-2.39) compared with the general population; this effect was mitigated among non-GI cancer survivors (food insecurity: aOR 1.22; any HRSN: aOR 1.09; multiple HRSNs: aOR 1.36; housing insecurity: p = 0.181).

conclusionCancer survivors, particularly individuals with GI cancer, faced greater financial hardship and were more likely to be burdened by HRSNs. Routine screening and targeted interventions are warranted for all cancer survivors, with even greater focus on financially burdened GI cancer survivors. IMPLICATIONS FOR CANCER SURVIVOR: Routine screening and targeted interventions are warranted for all cancer survivors, with even greater focus on financially burdened GI cancer survivors.