The association of health insurance literacy and numeracy with financial toxicity and hardships among colorectal cancer survivors

Jean S. Edward, Mary Kay Rayens, Xiaomei Zheng, Robin C. Vanderpool

Research output: Contribution to journalArticlepeer-review

12 Citations (SciVal)


Purpose: In this study, we examined the association of financial hardship measured by material financial burden and financial toxicity with health insurance literacy and numeracy among colorectal cancer survivors. The lack of evidence on the impact of cost-related health literacy, specifically health insurance literacy and numeracy, on financial toxicity among cancer survivors warrants further research. Methods: Between January and November 2019, we used a cross-sectional research design to collect surveys from 104 colorectal cancer survivors (diagnosed within last 5 years) from the Kentucky Cancer Registry. Survey items assessed health insurance literacy (measured by confidence and behaviors in choosing and using health insurance), numeracy, material financial burden, and financial toxicity, in addition to socio-demographic variables. Survey data were subsequently linked to the participant’s cancer registry record. Data were analyzed using descriptive, bivariate, and multiple linear regression analyses. Results: The mean financial toxicity score was 24.5, with scores ranging from 3 to 43 (higher scores indicating greater financial toxicity). Eighty percent of participants indicated they had experienced one or more material burdens related to their cancer. The majority had adequate health insurance (79%); however, the majority also had low numeracy (84%). After controlling for socio-demographic covariates, significant predictors of greater financial toxicity were high material burden scores, low health insurance literacy, and low numeracy. Conclusions: Findings indicate the need to develop programs and interventions aimed at improving health insurance literacy and numeracy as a strategy for reducing financial toxicity and hardships among colorectal cancer survivors.

Original languageEnglish
Pages (from-to)5673-5680
Number of pages8
JournalSupportive Care in Cancer
Issue number10
StatePublished - Oct 2021

Bibliographical note

Funding Information:
This study was funded by the American Cancer Society Institutional Research Grant (#IRG 16-182-28).

Publisher Copyright:
© 2021, The Author(s), under exclusive licence to Springer-Verlag GmbH, DE part of Springer Nature.


  • Colorectal cancer
  • Cost-related health literacy
  • Financial toxicity
  • Health insurance literacy
  • Numeracy

ASJC Scopus subject areas

  • Oncology


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