Pilot: Examining the Relationship between Financial Toxicity, Cost-Related Health Literacy and Access to Cancer Care for Colorectal Cancer Survivors in Kentucky

Financial toxicity, or the undue financial burden and stress that patients face related to cancer care costs, is directly associated with poorer health-related quality of life, decreased survival and treatment compliance and increased symptom burden and mortality. The lack of evidence on the impact of cost-related health literacy, specifically health insurance literacy (HIL), on financial toxicity levels of cancer survivors warrants further research. In light of recent health care reform changes that have resulted in high-deductible health insurance plans and mounting cancer costs, the need to advance research on programs that improve costrelated health literacy of cancer survivors is needed. Improving cost-related health literacy of consumers influences their awareness of costs related to cancer care, and their ability to understand and appropriately use health insurance and other resources to manage costs, which in-turn could impact financial toxicity. The overall objective of this study is to examine consumer- and system-level factors that impact financial toxicity of colorectal cancer (CRC) survivors in Kentucky. To support these goals, this application will address the following aims: Aim 1: Examine the relationship between financial toxicity, cost-related health literacy, and access to cancer care for colorectal cancer survivors in Kentucky (consumer-level). Hypothesis 1a. CRC survivors with low cost-related health literacy will be more likely to experience high financial toxicity. Hypothesis 1b. CRC survivors with high financial toxicity will be more likely to delay or forgo accessing cancer care. Aim 2: Identify current approaches for HIL improvement and financial toxicity support related to cancer care delivery in Kentucky (system-level). Hypothesis 2: Current approaches to HIL improvement and financial toxicity support will be limited in availability and accessibility, especially in rural, Appalachian communities. To meet these aims, a cross-sectional, mixed methods, concurrent triangulation design guided by a conceptual framework for financial toxicity will be used. In Aim 1, surveys will be collected from 160 CRC survivors in Kentucky. Participants will be recruited in collaboration with the Kentucky Cancer Registry and data collection will occur in collaboration with Markey Cancer Center’s Behavioral and Community-Based Research, Shared Resource Facility. Survey data will be analyzed using descriptive, bivariate, and multiple linear regression analyses. In Aim 2, 20 key informant interviews will be conducted with providers at all 20 sites of Markey Cancer Center’s Affiliate Network. Interview data will be analyzed using descriptive coding, content analysis, and thematic data analysis techniques. Findings from this study will help establish the relationship between financial toxicity, cost-related health literacy and access to cancer care to help support future research. This study will culminate in the submission of an R21 aimed at developing a tailored intervention to improve cost-related health literacy and reduce financial toxicity among cancer survivors. The proposed study directly addresses the mission of the American Cancer Society by discovering effective, evidence-based methods to reduce the impact of financial toxicity on cancer survivors, which will result in diminished suffering from cancer and the saving of lives.