Correlates of cost-related medication rationing and non-adherence among cancer survivors in the US

Purpose: This study aims to describe the characteristics of cancer survivors who are at heightened risk of adopting cost-saving behaviors as a means to cope with financial hardship. Methods: Study data were derived from the 2018 National Health Interview Survey. Weighted multivariable logistic regressions were used to assess the relationship between cost-related medication rationing and non-adherence and the sociodemographic and behavioral characteristics of US cancer survivors. Results: A total of 2594 cancer survivors were respondents. As income increased, the odds of medication rationing and non-adherence decreased. Cancer survivors aged 65 years and older were less likely to skip or take less medication to save costs than those aged < 45 years. Compared to respondents with health insurance coverage, those without health insurance coverage were over two folds (aOR: 2.38, 95% CI: 1.07-5.29) more likely to skip medications (aOR: 2.38, 95% CI: 1.07-5.29) and take less medication (aOR: 3.53, 95% CI: 1.62-7.72) to save cost. Current smokers were more likely to skip medications (aOR: 1.98, 95% CI: 1.13-3.48) or take less medication (aOR: 1.99, 95% CI: 1.16-3.42) to save money compared to never-smokers. Conclusions: Cancer survivors who skip or ration medications are more likely to be younger, low-income, current smokers, with no health insurance coverage. Results call for multi-pronged interventions targeting at-risk groups identified in this study. Implications for Cancer Survivors: Smoking cessation, expanding insurance coverage for cancer survivors, and furthering ongoing governmental-level efforts aimed at reducing drug prices can help tackle financial hardship and improve outcomes for cancer survivors