All ETDs from UAB

Advisory Committee Chair

Eric W Ford

Advisory Committee Members

Andres Azuero

Kelly M Kenzik

Stephen T Mennemeyer

Gabrielle B Rocque

Document Type


Date of Award


Degree Name by School

Doctor of Public Health (DrPH) School of Public Health


Individuals with cancer are at risk of material, psychological, and behavioral financial hardship due to costly new treatments, increasing time on treatment, and longer survival. Breast cancer is an ideal environment to study financial hardship. Treatment options for metastatic breast cancer are heterogeneous due to differences in patient characteristics, disease biology, and because it has the largest number of treatment options of any metastatic cancer. In early stage breast cancer, treatment options include multimodality treatments, including surgery, radiation, and medical therapy (chemotherapy, hormone therapy, targeted therapy), with the choice for each modality being dependent on the other modality decisions. Despite increasing recognition of both direct and indirect medical care costs as substantial cancer-related concerns, few data are available on how treatment choice, treatment preferences, and health insurance literacy are potentially associated with financial hardship in individuals with breast cancer. Therefore, this dissertation is comprised of three research projects focused on understanding financial hardship in women with breast cancer. First, we will evaluate the patient-level impact of discordance with National Comprehensive Cancer Network treatment guidelines on patient cost responsibility in Medicare beneficiaries with metastatic breast cancer. Second, we will quantify breast cancer patient treatment preferences, distinct preference groupings, and their association with financial toxicity in a sample of patients previously in need of aid from an advocacy foundation. Third, we will explore the association between financial hardship and health insurance literacy in women receiving metastatic breast cancer care in the Deep South. These contributions will be significant, because they will increase knowledge on how treatment type, treatment preferences, and health insurance literacy may impact the material conditions, psychological response, and coping behaviors related to the financial hardship experienced by women with breast cancer.

Included in

Public Health Commons



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