Financial and employment impacts of cancer and COVID-19 among african american cancer survivors

ABSTRACT

Purpose: Financial hardship due to cancer is more common among African American than White survivors. The COVID-19 pandemic and its economic fallout have also disproportionately affected African Americans. The purpose of this study is to describe the financial and employment impacts of COVID-19 in a population of African American cancer survivors and to compare those impacts with those experienced after a cancer diagnosis. Methods: Results include survey data from 593 participants in the population-based Detroit Research on Cancer Survivors (ROCS) cohort who completed the ROCS enrollment survey and a supplemental questionnaire related to the impact of the COVID-19 pandemic on their financial wellbeing and employment. Most participants (96%) were not diagnosed with COVID-19 by the time they completed the supplement and reflect the societal impact of the pandemic rather than a personal COVID-19 diagnosis. Analyses compare reports of financial hardship (using assets, borrowing money, experiencing debt, decreases in income) and employment impacts (changes to work schedules, duties, hours, employment status) due to cancer and due to the COVID-19 pandemic. Results: A similar proportion of ROCS participants reported financial hardship (41% vs. 42%) and borrowing money (5% vs. 6%) related to the COVID pandemic and their cancer diagnosis, respectively. Fewer survivors reported borrowing money (9% vs. 17%;p<0.001) or experiencing a decrease in income due to COVID than cancer (20% vs. 28%;p = 0.001);however;more reported debt associated with COVID (30% vs. 17%;p<0.001). Changes to work schedules (44% vs. 36%) and hours worked (44% vs. 28%) related to the COVID pandemic and cancer were common, and not statistically different from one another. More survivors changed their work duties due to the COVID pandemic (20%) than cancer (12%;p = 0.048). Prevalence of changes to employment status were similar for cancer (6%) and COVID (11%). Conclusions: The COVID-19 pandemic was associated with similar levels of overall financial hardship, and higher prevalence of debt and some work changes, than individual cancer experiences. These additional burdens on a financially vulnerable population could exacerbate existing cancer-related inequities.