Objectives Black cancer survivors report higher rates of depression, pain, and fatigue compared to other races/ethnicities. We sought to evaluate the association between healthcare affordability (HA) and supportive care (SC) medication utilization among ovarian cancer (OC) patients by race.
Methods Data for Non-Hispanic White (NHW), Non-Hispanic Black (NHB), and Hispanic OC patients diagnosed in 2008–2015 in the SEER-Medicare database was analyzed. Factor analysis was used to determine a composite score for HA. SC medication utilization included receipt of antidepressants, psychostimulants, and analgesics. Multivariable log-binomial regression was used to evaluate associations between race/ethnicity, affordability, and SC medication use in the 6 months following OC diagnosis with adjustment for patient clinical characteristics. Sub-group analyses were performed evaluating these associations among late-stage (stage III-IV) patients.
Results The cohort included 3,697 patients: 86% NHW, 6% NHB, and 8% Hispanic. In adjusted models, patients with lower affordability scores were less likely to receive antidepressants compared to those with higher affordability scores (all stage: aOR 0.84; 95% CI 0.73–0.96 and late-stage: aOR 0.85; 95% CI 0.72–0.99). Additionally, NHB were less likely to receive antidepressants compared to NHW patients (all stage: aOR 0.46; 95% CI 0.33–0.63 and late-stage: aOR 0.36; 95% CI 0.24–0.56). There was no association between affordability and psychostimulant or analgesic utilization.
Conclusions Low healthcare affordability is associated with lower utilization of antidepressants among OC patients, and NHB patients are less likely to receive antidepressants. This indicates the need for interventions targeting more affordable and equitable access to these supportive care medications.
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