Patients with cancer have lower odds of financial hardship if they have higher health insurance literacy, according to a study published in JAMA Network Open.

Researchers enrolled 404 cancer patients from 2 ambulatory infusion centers in this cross-sectional survey study.

The team assessed each patient’s perspective about their financial situation with the 12-item Comprehensive Score for Financial Toxicity-Functional Assessment of Chronic Illness Therapy (COST-FACIT) and the National Health Interview Survey. The assessment touched on 3 different hardship domains: material, psychological, and behavioral.

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The researchers also used the Health Insurance Literacy Measure (HILM) to learn more about the patients’ ability to select and use health insurance. And the team assessed financial literacy of the participants with the National Financial Capability Study.

The percentage of patients with financial hardship was 49% according to COST–FACIT score but 68% according to the National Health Interview Survey results. Two-thirds of patients (66%) had high financial literacy, and the mean HILM score was 64.9 points.

The researchers found that, in multivariable analyses, each 10-point increase in HILM score was associated with significantly lower odds of financial hardship (odds ratio, 0.82; 95% CI, 0.68-0.99; P =.04). However, the association was no longer significant when the researchers adjusted for financial literacy.

The researchers noted that this study was limited by a relatively small sample size and the fact that participants were self-reporting data, which could have introduced recall and reporting biases. The researchers also noted that patients with higher health insurance and financial literacy may have been more motivated to respond to the surveys. In addition, only one quarter of the participants were members of racial and ethnic minority groups, which may further limit the generalizability of the results to a broad, increasingly diverse population.

However, the researchers concluded that their findings would be useful in creating tailored interventions for diverse populations in the future, given how overwhelming a cancer diagnosis can be with the additional stress of the financial aspects.

“In this survey study, increased health insurance literacy was associated with lower odds of financial hardship especially affecting the material and behavioral domains,” the researchers concluded.  “We also found that high financial literacy may help to mitigate the adverse outcomes associated with lower health insurance literacy.”


Khera N, Zhang N, Hilal T, et al. Association of health insurance literacy with financial hardship in patients with cancer. JAMA Netw Open. 2022;5(7):e2223141. doi:10.1001/jamanetworkopen.2022.23141

This article originally appeared on Oncology Nurse Advisor