Financial hardship among rural cancer survivors: An analysis of the Medical Expenditure Panel Survey

Cassie L. Odahowski, Whitney E. Zahnd, Anja Zgodic, Jean S. Edward, Lauren N. Hill, Melinda M. Davis, Cynthia K. Perry, Jackilen Shannon, Stephanie B. Wheeler, Robin C. Vanderpool, Jan M. Eberth

Research output: Contribution to journalArticlepeer-review

17 Scopus citations


Some cancer survivors report spending 20% of their annual income on medical care. Undue financial burden that patients face related to the cost of care is referred to as financial hardship, which may be more prevalent among rural cancer survivors. This study examined contrasts in financial hardship among 1419 rural and urban cancer survivors using the 2011 Medical Expenditure Panel Survey supplement – The Effects of Cancer and Its Treatment on Finances. We combined four questions, creating a measure of material financial hardship, and examined one question on financial worry. We conducted multivariable logistic regression analyses, which produced odds ratios (OR) for factors associated with financial hardship and worry, and then generated average adjusted predicted probabilities. We focused on rural and urban differences classified by metropolitan statistical area (MSA) designation, controlling for age, education, race, marital status, health insurance, family income, and time since last cancer treatment. More rural cancer survivors reported financial hardship than urban survivors (23.9% versus 17.1%). However, our adjusted models revealed no significant impact of survivors' MSA designation on financial hardship or worry. Average adjusted predicted probabilities of financial hardship were 18.6% for urban survivors (Confidence Interval [CI]: 11.9%–27.5%) and 24.2% for rural survivors (CI: 15.0%–36.2%). For financial worry, average adjusted predicted probabilities were 19.9% for urban survivors (CI: 12.0%–31.0%) and 18.8% for rural survivors (CI: 12.1%–28.0%). Improving patient-provider communication through decision aids and/or patient navigators may be helpful to reduce financial hardship and worry regardless of rural-urban status.

Original languageEnglish
Article number105881
JournalPreventive Medicine
StatePublished - Dec 2019

Bibliographical note

Publisher Copyright:
© 2019


  • Cost of illness
  • Health expenditures
  • Health surveys
  • Neoplasms
  • Psychological
  • Rural health
  • Stress
  • Survivors

ASJC Scopus subject areas

  • Epidemiology
  • Public Health, Environmental and Occupational Health


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