Currently submitted to: JMIR Cancer
Date Submitted: Sep 14, 2026
Open Peer Review Period: Sep 15, 2026 - Nov 10, 2026
(currently open for review)
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Material Hardship and Uncontrolled Cancer-Related Pain Among Cancer Survivors: A Cross-Sectional Analysis of 2022-2024 Behavioral Risk Factor Surveillance System Data
ABSTRACT
Background:
Material hardship may interfere with access to cancer care and symptom management, but its relationship with control of cancer-related pain is not well characterized.
Objective:
This study examined whether difficulty paying bills, transportation insecurity, and utility insecurity were associated with uncontrolled cancer-related pain among adults reporting current pain caused by cancer or cancer treatment.
Methods:
We conducted a cross-sectional analysis of 2022-2024 Behavioral Risk Factor Surveillance System data. The analytic sample included 1,225 respondents with current cancer-related pain and complete outcome, hardship, demographic, and survey-design data. Complex-survey weights, strata, and primary sampling units were incorporated. Weighted prevalence estimates, Rao-Scott chi-square tests, and survey-weighted logistic regression models were used to evaluate associations between material hardship and uncontrolled pain. Adjusted models included age group, sex, and income group, with survey year additionally included in the pooled model.
Results:
The weighted prevalence of uncontrolled cancer-related pain was higher among respondents reporting difficulty paying bills (45.0% vs 21.4%), transportation insecurity (50.2% vs 20.5%), and utility insecurity (42.0% vs 22.6%) than among respondents without the respective hardship. In the pooled adjusted model, transportation insecurity was associated with greater odds of uncontrolled cancer-related pain (adjusted odds ratio 2.65; 95% CI, 1.40-5.01; P=.0028). Difficulty paying bills (adjusted odds ratio 1.44; 95% CI, 0.72-2.91) and utility insecurity (adjusted odds ratio 1.13; 95% CI, 0.52-2.43) were not independently associated with uncontrolled pain after adjustment.
Conclusions:
Material hardship was accompanied by a higher weighted prevalence of uncontrolled cancer-related pain, while transportation insecurity was the only hardship independently associated with uncontrolled pain in the pooled adjusted model. Screening for transportation barriers may identify cancer survivors at increased risk of inadequate pain control.
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