Self-reported administrative burden in people with recently diagnosed breast cancer.

Abstract

172 Background: Health insurance, employment benefits and financial assistance programs may reduce cancer-related financial hardship, but administrative hurdles that require interacting with benefit providers can limit access to these benefits. Administrative hurdles limit access to public benefits (e.g. food assistance), but their impact on people with cancer is unclear. Our objective was to estimate the prevalence of administrative burden related to cancer and its treatment. Methods: We conducted an exploratory analysis of cross-sectional survey data whose primary purpose was to develop item banks measuring cancer-related financial hardship. The self-administered survey was conducted in 2023-2024 among adults age ≥18 years with breast cancer diagnosed in the previous 2 years selected using the Surveillance, Epidemiology and End-Results (SEER) in the Puget Sound Area of Washington State. Based on public policy literature that defines administrative burden as the learning, compliance, or psychological costs of interacting with the state, we selected 49 survey items representing hurdles likely requiring interaction with administrative entities. We categorized each hurdle as related to health care (e.g. unexpected bills), health insurance (e.g. denial of coverage), employment or disability benefits, seeking financial assistance, or meeting basic needs (e.g. disconnected utilities). We also categorized each as learning, compliance (unexpected or expected), or psychological costs. We calculated the prevalence of each hurdle, hurdle type, and total (cumulative) hurdles for the whole sample and for age and race/ethnicity subgroups. Results: The survey response rate was 15.5%. The sample (n=598) was 98% female, 8% Asian race, 7% other race, 83% White; 4% Hispanic ethnicity; 55% age 18-64; 49% household income less than $100k; and 67% married. 80% of the sample reported 1 or more administrative hurdle (mean 5.6 hurdles, SD 5.7, range 0-30). Most frequently reported hurdles were tracking health insurance claims (n=315) and receiving unexpected bills (n=237). 74% of the sample reported at least one health insurance hurdle, and 56% reported at least one health care-related hurdle; followed by employment or disability 28%; financial assistance (28%); and meeting basic needs (15%). 63% of people reported unexpected compliance-related hurdles; emotional burdens by 54%; and learning burdens by 25%. Hurdles were disproportionately reported by people age 18-64 (mean 7.8 hurdles), reporting Hispanic ethnicity (mean 10.2), or race other than White or Asian (mean 7.9). Conclusions: This exploratory analysis suggests that people with breast cancer experience multiple administrative hurdles that require interaction with benefit providers, and disproportionate experience of hurdles by age and race/ethnicity. Future analyses will include associations with mental health and care access outcomes.