Financial Toxicity Among Disaggregated Asian American Cancer Survivors
Advait Thaploo, Edward Christopher Dee, Kaitlyn Lapen, Fumiko ChinoImportance
Panethnic categorization of Asian American individuals masks sociodemographic diversity. Whether this aggregation obscures heterogeneity in cancer-related financial toxicity remains unknown due to a lack of disaggregated data.
Objective
To evaluate associations between disaggregated Asian American identity and financial toxicity among cancer survivors compared with non-Hispanic White survivors.
Design, Setting, and Participants
This cross-sectional study analyzed National Institutes of Health All of Us Research Program data. Participants were Asian American and non-Hispanic White adults with an electronic health record–confirmed malignant neoplasm diagnosed before completing financial toxicity surveys. Surveys were completed between June 2018 and December 2024; analyses concluded July 2026.
Exposures
Self-reported Asian and non-Hispanic White race; self-reported Chinese, Filipino, Indian or Pakistani, Japanese, Korean, and Vietnamese ethnicity.
Main Outcomes and Measures
Three financial toxicity domains were assessed: cost-related nonadherence, foregone medical care, and financial worry. Adjusted odds ratios (AORs) were estimated using multivariable logistic regression adjusting for clinical covariates, with sequential adjustment for socioeconomic factors and nativity.
Results
The cohort included 55 511 survivors (median [IQR] age, 66.0 [56.0-73.0] years): 54 230 (97.7%) non-Hispanic White and 1281 (2.3%) Asian American individuals. Overall, 27 316 (49.2%) experienced at least 1 financial toxicity domain. In the clinical baseline model, Chinese survivors had lower odds of cost-related nonadherence than non-Hispanic White survivors (AOR, 0.68; 95% CI, 0.53-0.88). Vietnamese (AOR, 2.15; 95% CI, 1.30-3.56), Filipino (AOR, 1.58; 95% CI, 1.22-2.07), and Japanese (AOR, 1.44; 95% CI, 1.10-1.89) survivors had higher odds of financial worry than non-Hispanic White survivors. In aggregate, Asian American identity was associated with lower cost-related nonadherence odds (AOR, 0.79; 95% CI, 0.69-0.92) and higher financial worry odds (AOR, 1.31; 95% CI, 1.16-1.47). Worry associations attenuated after nativity adjustment.
Conclusions and Relevance
In this cross-sectional study, disaggregation revealed heterogeneity in financial toxicity across Asian American subgroups, which was obscured by panethnic classification. Elevated financial worry may reflect immigration factors and US wealth accumulation rather than income alone. Disaggregated data are needed to effectively target financial navigation.