Medical Financial Hardship and Food Security among Cancer Survivors in the United States

Cancer Epidemiol Biomarkers Prev. 2023 Aug 1;32(8):1038-1047. doi: 10.1158/1055-9965.EPI-22-1044.


Background: Some cancer survivors experience medical financial hardship, which may reduce their food security. The purpose of this study was to explore whether medical financial hardship is related to food security among cancer survivors.

Methods: The study was based on cross-sectional data from the 2020 National Health Interview Survey. We used ordinal logistic regression to examine the relationship between material, psychological, and behavioral medical financial hardships and household food security (i.e., high, marginal, low, or very low) among individuals ages ≥18 years who reported a cancer diagnosis from a health professional (N = 4,130).

Results: The majority of the sample reported high household food security (88.5%), with 4.8% reporting marginal, 3.6% reporting low, and 3.1% reporting very low household food security. In the adjusted model, the odds of being in a lower food security category were higher for cancer survivors who had problems paying or were unable to pay their medical bills compared with those who did not [OR, 1.73; 95% confidence interval (CI), 1.06-2.82, P = 0.027], who were very worried about paying their medical bills compared with those who were not at all worried (OR, 2.88; 95% CI, 1.64-5.07; P < 0.001), and who delayed medical care due to cost compared with those who did not (OR, 2.56; 95% CI, 1.29-5.09; P = 0.007).

Conclusions: Food insecurity is rare among cancer survivors. However, medical financial hardship is associated with an increased risk of lower household food security among cancer survivors.

Impact: A minority of cancer survivors experience medical financial hardship and food insecurity; social needs screenings should be conducted.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Cancer Survivors*
  • Cost of Illness
  • Cross-Sectional Studies
  • Financial Stress
  • Food Security
  • Humans
  • Neoplasms*
  • United States / epidemiology