An Intersectional Analysis of Behavioral Financial Hardship and Healthcare Utilization among LGBTQ+ Cancer Survivors

UNC Libraries · 2026-01-03

BACKGROUND: lesbian, gay, bisexual, transgender, queer, or another non-heterosexual 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. METHODS: LGBTQ+ 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 (AME), 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. RESULTS: This analysis included N = 36,217 cancer survivors (6.6%, n = 2,399 LGBTQ+). In multivariable models, LGBTQ+ identity was associated with higher probabilities of and significant AME 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. CONCLUSIONS: LGBTQ+ cancer survivors experience significantly more behavioral financial hardship and non-cost-related delayed care then non-LGBTQ+ cancer survivors. Interventions at the individual, system, and policy level are needed to address LGBTQ+ inequities in financial hardship.

Treatment Initiation Among Black and White Older Adults With Multiple Myeloma: A <scp>SEER</scp> ‐Medicare Analysis

Cancer Medicine · 2026-01-26

BACKGROUND: This study aims to describe time to treatment initiation for Black and White older adults with multiple myeloma (MM), and to test the hypothesis that Black/White disparities in treatment initiation have increased over time. METHODS: Black and White older adults (65+) diagnosed with myeloma 2007-2017 were identified in the SEER-Medicare database. Continuous Medicare Parts A/B coverage 12 months before and after diagnosis or until death, and Part D coverage for 12 months following diagnosis or until death were required for inclusion. We explored time to treatment initiation by race across three diagnosis time periods (2007-10, 2011-2014, 2015-2017) using Cox proportional hazard models. We estimated cumulative incidence of treatment initiation by race at 3, 6, and 12 months after diagnosis for all time periods. RESULTS: White MM patients were more likely to initiate treatment than Black MM patients across time periods. Hazard ratios (HR) and 95% confidence intervals (CI) ranged from HR = 1.35 (95% CI: 1.25, 1.46) to HR = 1.36 (95% CI: 1.27, 1.44). Black/White differences in the cumulative incidence of treatment initiation at 3, 6, and 12 months were also significant and persistent across time periods, ranging from 0.09 (95% CI: 0.02, 0.15) to 0.11 (95% CI: 0.05, 0.17). Contrary to our hypothesis, Black/White disparities were not increasing over time. CONCLUSION: Our results suggest that Black patients initiate MM treatment later than White patients and are less likely to ever initiate treatment. Contrary to our hypothesis, Black/White disparities are not increasing over time and have remained static.

Treatment Initiation Among Black and White Older Adults With Multiple Myeloma: A SEER‐Medicare Analysis

Open MIND · 2026-01-01

Background This study aims to describe time to treatment initiation for Black and White older adults with multiple myeloma (MM), and to test the hypothesis that Black/White disparities in treatment initiation have increased over time. Methods Black and White older adults (65+) diagnosed with myeloma 2007&ndash;2017 were identified in the SEER‐Medicare database. Continuous Medicare Parts A/B coverage 12&thinsp;months before and after diagnosis or until death, and Part D coverage for 12&thinsp;months following diagnosis or until death were required for inclusion. We explored time to treatment initiation by race across three diagnosis time periods (2007&ndash;10, 2011&ndash;2014, 2015&ndash;2017) using Cox proportional hazard models. We estimated cumulative incidence of treatment initiation by race at 3, 6, and 12&thinsp;months after diagnosis for all time periods. Results White MM patients were more likely to initiate treatment than Black MM patients across time periods. Hazard ratios (HR) and 95% confidence intervals (CI) ranged from HR&thinsp;=&thinsp;1.35 (95% CI: 1.25, 1.46) to HR&thinsp;=&thinsp;1.36 (95% CI: 1.27, 1.44). Black/White differences in the cumulative incidence of treatment initiation at 3, 6, and 12&thinsp;months were also significant and persistent across time periods, ranging from 0.09 (95% CI: 0.02, 0.15) to 0.11 (95% CI: 0.05, 0.17). Contrary to our hypothesis, Black/White disparities were not increasing over time. Conclusion Our results suggest that Black patients initiate MM treatment later than White patients and are less likely to ever initiate treatment. Contrary to our hypothesis, Black/White disparities are not increasing over time and have remained static.

Treatment Initiation Among Black and White Older Adults With Multiple Myeloma: A SEER‐Medicare Analysis

UNC Libraries · 2026-02-06

Background This study aims to describe time to treatment initiation for Black and White older adults with multiple myeloma (MM), and to test the hypothesis that Black/White disparities in treatment initiation have increased over time. Methods Black and White older adults (65+) diagnosed with myeloma 2007&ndash;2017 were identified in the SEER‐Medicare database. Continuous Medicare Parts A/B coverage 12&thinsp;months before and after diagnosis or until death, and Part D coverage for 12&thinsp;months following diagnosis or until death were required for inclusion. We explored time to treatment initiation by race across three diagnosis time periods (2007&ndash;10, 2011&ndash;2014, 2015&ndash;2017) using Cox proportional hazard models. We estimated cumulative incidence of treatment initiation by race at 3, 6, and 12&thinsp;months after diagnosis for all time periods. Results White MM patients were more likely to initiate treatment than Black MM patients across time periods. Hazard ratios (HR) and 95% confidence intervals (CI) ranged from HR&thinsp;=&thinsp;1.35 (95% CI: 1.25, 1.46) to HR&thinsp;=&thinsp;1.36 (95% CI: 1.27, 1.44). Black/White differences in the cumulative incidence of treatment initiation at 3, 6, and 12&thinsp;months were also significant and persistent across time periods, ranging from 0.09 (95% CI: 0.02, 0.15) to 0.11 (95% CI: 0.05, 0.17). Contrary to our hypothesis, Black/White disparities were not increasing over time. Conclusion Our results suggest that Black patients initiate MM treatment later than White patients and are less likely to ever initiate treatment. Contrary to our hypothesis, Black/White disparities are not increasing over time and have remained static.

Trends in End-of-Life Care Quality Among Patients With Cancer, 2003 to 2019

American Journal of Hospice and Palliative Medicine® · 2026-01-31

BackgroundAs cancer remains a leading cause of death for older adults, ensuring high-quality end-of-life (EOL) care is a critical component of cancer care. Prior studies have predominantly assessed EOL care for racial and ethnic disparities or among one cancer type. Therefore, using a population-based sample, our objective was to describe EOL care among decedents with cancer across various social and clinical characteristics.MethodsThis retrospective cohort study used 2003-2019 data from The University of North Carolina at Chapel Hill Cancer Information and Population Health Resource, which links cancer registry to administrative claims data in North Carolina. We examined five EOL practices within the last 30 days of life including: >1 emergency department (ED) visit, intensive care unit (ICU) admission, hospital admission, intravenous (IV) chemotherapy, and no hospice use. We assessed in-hospital death and late hospice initiation in the last 3 days of life. We descriptively assessed differences in EOL by various demographic characteristics.ResultsAmong 150 412 decedents, 48% were female, 23% were non-Hispanic Black, and 61% were Medicare beneficiaries. The most frequent EOL care practice was hospital admission (54%). Over time, no hospice use, ICU admission, hospital admissions, and in-hospital deaths decreased. However, in 2019, hospital admissions and no hospice use were still high (52% & 38%, respectively). Compared to patients with other insurance, Medicaid decedents had the best quality EOL care: ED visit (9%), hospital admission (45%), and hospice initiation in the last 3 days (6%).ConclusionsAdditional research is needed to understand what could be driving these observed differences. Interventions, such as EOL patient navigation, could improve upon EOL care in patients with cancer.

What Money Cannot Buy: Addressing the Socioeconomic Status Ceiling Effect for Black Patients Across Cancer Types

Journal of Clinical Oncology · 2026-04-21

Timing of <i>BRCA</i> Genetic Testing and Surgical Decision-Making Among Young Black Women With Breast Cancer

Cancer Control · 2025-12-01

Introduction Genetic testing for hereditary cancer syndromes, particularly BRCA1 and BRCA2 ( BRCA ) germline pathogenic or likely pathogenic variants (GPVs), is critical in informing surgical decisions for women with breast cancer. Young Black women are historically underrepresented in genetic testing and research, making it essential to understand how testing timing influences treatment choices. We evaluated how the timing of BRCA testing affected surgical management among young Black women with breast cancer. Methods Participants were drawn from a population-based cohort of Black women diagnosed with invasive breast cancer at age 50 or younger, recruited via Florida and Tennessee cancer registries. Data were collected through structured questionnaires, electronic health records, and lab reports, including information on genetic testing, BRCA status, and treatment. Participants were categorized by timing of BRCA testing (pre-surgical vs post-surgical) and GPV status. Chi-squared tests assessed associations between testing timing, BRCA status, and surgical treatment. Results Among 633 participants, people with a BRCA GPV who were tested before surgery (n = 29) were significantly more likely to undergo bilateral mastectomy (82.8%) than those tested after surgery (40%). Timing of testing and BRCA status were both strongly associated with surgery received ( P &lt; 0.0001). Conclusion BRCA testing at diagnosis and prior to surgery is significantly associated with surgical management in young Black women with breast cancer. These findings highlight the importance of timely genetic testing, especially in populations with historically lower testing rates.

Supplemental Figure 1 from Applying a Novel Measure of Community-Level Healthcare Access to Assess Breast Cancer Care Timeliness

2025-07-01

&lt;p&gt;Supplemental Figure 1: Cell values are predicted means for variables (normalized by square root transformation) used in the latent class model. Predicted means are conditional given classification into a latent class group (listed along the top row). Reading across a row, a cell with a relatively high value (compared to others in the row) indicates higher frequency of the given characteristic in that latent class group compared to other latent class groups. Ns correspond to the number of North Carolina census tracts in each group.&lt;/p&gt;

Supplemental Table 3 from Applying a Novel Measure of Community-Level Healthcare Access to Assess Breast Cancer Care Timeliness

2025-07-01

&lt;p&gt;Supplemental Table 3: Alternate models are shown for delayed and prolonged treatment with stratification (rather than adjustment, as in the main analysis) for patients with stage I, II, or III-IV breast cancer.&lt;/p&gt;

Racial discrimination and health-care system trust among American adults with and without cancer

UNC Libraries · 2025-06-28

BACKGROUND: Racial and ethnic minoritized groups report disproportionately lower trust in the healthcare system. Lower healthcare system trust is potentially related to increased exposure to racial discrimination in medical settings, but this association is not fully understood. We examined the association between racial discrimination in medical care and trust in the healthcare system among people with and without a personal cancer history. METHODS: We examined racial discrimination and trust in a nationally representative American adult sample from the Health Information National Trends Survey 6. Racial discrimination was defined as any unfair treatment in healthcare based on race or ethnicity. Trust in the healthcare system (eg, hospitals and pharmacies) was grouped into low, moderate, and high trust. Multinomial logistic regression models were used to compare low and moderate trust relative to high trust in the healthcare system and estimate odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS: A total of 5,813 respondents (15% with a personal cancer history) were included 92% (n&thinsp;=&thinsp;5,355) reported no prior racial discrimination experience during medical treatment. Prior experiences of racial discrimination were positively associated with low (OR&thinsp;=&thinsp;6.12, 95% CI: 4.22-8.86) and moderate (OR&thinsp;=&thinsp;2.70, 95% CI: 1.96-3.72) trust in the healthcare system, relative to high trust. Similar associations were observed when stratifying by personal cancer history. CONCLUSION: Respondents who reported racial discrimination during medical encounters had lower trust in the healthcare system, especially respondents with a personal cancer history. Our findings highlight the need to address racial discrimination experiences during medical care to build patient trust and promote healthcare access.