Racial disparities in access to prescription medications among American patients with cancer.

173 Background: Though the associations between Black race and increased rates of financial toxicity, as well as Black race and reduced cancer survival, are well-established, further exploration of the mechanisms connecting these two phenomena is required. One channel that has not yet been explored regards access to necessary medications. Cancer may cause financial toxicity, which in turn may reduce patients’ abilities to obtain their required medications, further exacerbating the quantity and/or intensity of medical conditions. In this study, we investigate self-reported access to prescribed medications in the ten cancers with greatest incidence in the United States, regressing on Black race while controlling for covariates. Methods: From the National Health Interview Survey (NHIS) from 2000 – 2020, we extracted data on Breast, Prostate, Lung, Colon, Melanoma, Bladder, Lymphoma, Kidney, Uterine, and Pancreatic cancers. The key outcome measure of financial toxicity used was the NHIS entry “needed but couldn’t afford prescription medicines, past 12 months,” a dichotomous variable. Multivariable logistic regressions on being Black (with reference variable White), controlling for sex (except for in Prostate and Uterine cancers), age first diagnosed with the cancer of interest, having an undergraduate degree, United States citizenship, having annual income greater than $50,000, having health insurance, and year of survey, were run in RStudio (Version 2021.09.1), separately for each cancer. Alpha was set at p < 0.05. Results: In the following six cancers, Black individuals were significantly more likely to not have been able to afford a needed prescription medicine in the last 12 months: Breast (OR = 2.05, p < 0.001, n = 7328), Prostate (OR = 2.91, p < 0.001, n = 4782), Colon (OR = 2.21, p < 0.001, n = 2330), Melanoma (OR = 6.58, p < 0.001, n = 2780), Lymphoma (OR = 2.29, p = 0.004, n = 1202), and Uterine (OR = 1.66, p = 0.030, n = 1640). Conclusions: Financial toxicity-induced disparities in access to prescription medications permeate six of the ten most common cancers in the United States. Given the self-reinforcing feedback loop nature of cancer-related financial toxicity, missing needed medications, and economic standing, particularly for Black patients, there is an urgent need for public investment in programs targeted at increasing prescription medication access. Such policies could substantially reduce racial disparities in American oncology. Future research should include additional biological covariates (such as disease severity) and further address the social determinants of health.