# Financial Hardship among LGBTQ+ Cancer Survivors and Caregivers: Prevalence, Determinants, and Access to Care

> **NIH AHRQ R36** · UNIV OF NORTH CAROLINA CHAPEL HILL · 2024 · $45,170

## Abstract

Abstract
Significance: Lesbian, gay, bisexual, transgender and other sexual and gender minority (LGBTQ+)
populations make up a substantial proportion of the United States (US) population—over 23 million individuals.
LGBTQ+ populations throughout the US face identity-related stigma, ranging from interpersonal to structural,
that leads to a variety of physical, mental, and economic health disparities. At the same time, the rising costs of
cancer care puts over half of cancer survivors at risk of financial hardship and the subsequent outcomes—poor
quality of life and reduces access to care. Emerging research suggests that LGBTQ+ cancer survivors and
caregivers may experience worse financial hardship in comparison to non-LGBTQ+ counterparts, driven by
existing economic inequities and multi-level anti-LGBTQ+ stigma. However, inequity in financial burden has not
been estimated using national datasets, nor, has an intersectional lens been taken to dig into the diversity of
the LGBTQ+ population. Innovation: Employing multiple national datasets with sexual orientation and gender
identity data (SOGI) data (Aims 1 and 2) as well as an explanatory sequential mixed-methods design with in-
depth qualitative interviews (Aim 3) provides a novel opportunity to provide national findings among LGBTQ+
cancer survivors paired with in-depth experiences of LGBTQ+ cancer caregivers. Integration of cancer-related
financial hardship frameworks and the theory of intersectionality is not only responsive to national calls to
center health equity (NOT-HS-21-014) it allows, for the first time, comprehensive and robust estimates to be
generated for LGBTQ+ cancer survivors of diverse identities. Aims: Aim 1 will use multivariable logit
regression to estimate inequities in material, behavioral, and psychological financial hardship between LGB
(e.g., lesbian, gay, bisexual) and non-LGB cancer survivors in the National Health Interview Survey. Aim 2 will
employ intersectional analyses to estimate inequity in behavioral financial hardship across identities and ages
between LGBTQ+ and non-LGBTQ+ cancer survivors in the All of Us Research Program dataset. Aim 3 will
use an explanatory sequential mixed-methods design including in-depth qualitative interview building on an
existing federally funded parent grant study. Aim 3 analyses will describe the lived experience of financial
burden among LGBTQ+ cancer caregivers as well as provide multi-level LGBTQ+ specific recommendations.
Study Impact: This study employs multiple data sources that each provide unique and important context to
LGBTQ+ inequities in financial hardship. Affordability is crucial to access to care, thus understanding the
between and within LGBTQ+ community variation in financial hardship promotes equity in health services
delivery. Overall, the purpose of this study is to estimate inequity, identify modifiable factors, and elicit
LGBTQ+ recommendations to improve the provision of cancer health services to LGBTQ+ popul...

## Key facts

- **NIH application ID:** 10976488
- **Project number:** 1R36HS030175-01
- **Recipient organization:** UNIV OF NORTH CAROLINA CHAPEL HILL
- **Principal Investigator:** Austin Richard Waters
- **Activity code:** R36 (R01, R21, SBIR, etc.)
- **Funding institute:** AHRQ
- **Fiscal year:** 2024
- **Award amount:** $45,170
- **Award type:** 1
- **Project period:** 2024-08-01 → 2025-07-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10976488

## Citation

> US National Institutes of Health, RePORTER application 10976488, Financial Hardship among LGBTQ+ Cancer Survivors and Caregivers: Prevalence, Determinants, and Access to Care (1R36HS030175-01). Retrieved via AI Analytics 2026-05-25 from https://api.ai-analytics.org/grant/nih/10976488. Licensed CC0.

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