“Gender difference in CRN is an important topic, but is relatively understudied,” James Zhang, PhD, director of Medicare innovation analysis at the University of Chicago, Illinois, said in an email to Cancer Therapy Advisor. “The gender difference in CRN is a complex phenomenon, which is driven in part by socio-economic status and consumer behavior.”

Dr Zhang coauthored a recent editorial that discussed the implications of gender-related CRN on theory, clinical practice, and policy.5 The authors wrote that while gender-related CRN is evidenced by several studies, there is not a clear understanding of why the problem is so prevalent.

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“It is difficult to give a definite estimate of the effect of the gender difference on CRN,” he told Cancer Therapy Advisor. “The independent factor of gender needs to be carefully explored by taking these other risk factors into account.”

Dr Zhang said that there is some evidence that suggests women face greater financial barriers to health care than men, and that those barriers lead to worse health outcomes. The “greatest challenge” to documenting the path between CRN and poor health outcomes is establishing a causal relationship with “the net effect of CRN on health outcomes,” he said.

But measuring this net effect is challenging, because CRN can lead patients into a kind of negative feedback loop in which worsening health leads to ever-increasing financial toxicity.

RELATED: Numerous Factors Contribute to Gender-based Disparity of Bladder Cancer Survival

Dr Zhang said more research into the causes of CRN would allow more targeted policy and the development of clinical screening tools for CRN. Screening tools would help clinicians to identify at-risk patients before CRN becomes a serious problem.


  1. Lee M, Khan MM. Gender differences in cost-related medication non-adherence among cancer survivors. J Cancer Surviv. 2016;10(2):384-93. doi: 10.1007/s11764-015-0484-5
  2. Nipp RD, Zullig LL, Samsa G, et al. Identifying cancer patients who alter care or lifestyle due to treatment-related financial distress. Psychooncology. 2016;25(6):719-25. doi: 10.1002/pon.3911
  3. Zhang JX, Meltzer DO. Risk factors for cost-related medication non-adherence among older patients with cancer. Integr Cancer Sci Ther. 2015;2(6):300-4.
  4. Soumerai SB, Pierre-Jacques M, Zhang F, et al. Cost-related medication nonadherence among elderly and disabled medicare beneficiaries: a national survey 1 year before the medicare drug benefit. Arch Intern Med. 2006;166(17):1829-35.
  5. Zhang JX, Meltzer DO. Is there a gender difference in cost-related medication non-adherence? J Gerontol Geriatr Res. 2016;5(2):e137. doi: 10.4172/2167-7182.1000e137