The scale of the survivor population makes these findings consequential. Recent estimates published in the Journal of the National Cancer Institute suggest that the number of cancer survivors in the United States continues to climb as treatments improve and the population ages, and women make up a substantial share of that group. Survivorship care, the coordinated follow-up that monitors for recurrence, manages late effects of treatment, and addresses general health, depends on reliable access to physicians. When that access falters, the clinical consequences can compound silently over years.

The Maryland study used multivariable logistic regression, a statistical technique that estimates the odds of an outcome while adjusting for other variables, to isolate the associations between sociodemographic factors and healthcare utilization. The results were striking. Survivors who were unemployed were 3.90 times more likely than employed survivors to report not being able to see a doctor because of cost, with a 95 percent confidence interval of 1.38 to 11.04. In plain terms, the loss of a paycheck translated directly into foregone medical visits, even among women who had already faced a cancer diagnosis and understood, perhaps better than anyone, why follow-up matters.

Income told a similar story over a longer horizon. Survivors with household incomes at or below $50,000 per year had 2.36 times the odds of not having seen a doctor in the past year compared with those earning more, with a confidence interval of 1.20 to 4.65. Annual check-ins with a physician are the backbone of surveillance after cancer treatment, the mechanism through which recurrences are caught early and treatment-related complications are managed. A gap of even a single year can shift the trajectory of a survivor’s health, and the data suggest that gap falls disproportionately on women with fewer financial resources.

Perhaps the most novel finding concerned housing. Survivors who did not own their homes had 61 percent lower odds of reporting that a general or family practitioner provided the majority of their care, with a confidence interval of 0.22 to 0.67. Homeownership functions here as a proxy for accumulated wealth and stability, a marker that captures more than income alone. Renters face housing costs that consume a larger share of their budgets, greater residential instability, and, as a growing body of literature on housing insecurity documents, systematically worse access to primary and preventive care. A systematic review published in the Journal of the National Cancer Institute in 2022 already linked housing circumstances to cancer care and outcomes; this study extends that evidence into the survivorship phase, where continuity of care is paramount.

The study also uncovered a statistical interaction between race and ethnicity and time since diagnosis in relation to seeing a doctor in the past year, a finding that reached significance at p equals 0.002. An interaction of this kind means the relationship between how recently a woman was diagnosed and whether she saw a physician was not uniform across racial and ethnic groups. The authors note that racial and ethnic minorities and economically disadvantaged populations may underuse healthcare throughout cancer survivorship, and the interaction suggests that the drop-off in care as time passes since diagnosis does not affect all groups equally. Disentangling why, whether through differences in insurance coverage, provider availability, trust in the medical system, or the cumulative burden of financial hardship, is a task the survey data alone cannot fully complete, but the signal is clear enough to demand attention.

Maryland offers an instructive setting for this work. The state operates a unique all-payer hospital rate-setting system, long studied as a laboratory for health care reform, and its population is diverse in both economic and racial terms. Yet even within this policy environment, the study found persistent disparities tied to economic stability. That persistence matters for policymakers: structural reforms to payment systems, however sophisticated, do not automatically dissolve the financial barriers that individual survivors face when deciding whether a doctor’s visit fits into a strained household budget.

The concept researchers call financial toxicity, the cumulative financial burden of cancer and its treatment, has gained traction in oncology over the past decade. Studies have documented that cancer survivors face elevated rates of bankruptcy, debt, and cost-related nonadherence to care. The Maryland findings add a specific dimension to that literature by focusing on women and by using multiple measures of economic stability rather than income alone. Employment status captured immediate cash-flow constraints, homeownership captured wealth and security, and household income captured overall resources. Each measure flagged a different failure point in the pathway to care, which suggests that no single intervention, whether insurance expansion or transportation assistance, will be sufficient on its own.

The authors argue that their findings demonstrate healthcare utilization disparities and highlight the need for targeted interventions for female cancer survivors in Maryland. Targeted is the operative word. Survivorship care models, which range from dedicated survivorship clinics to shared care between oncologists and primary care physicians, have proliferated in recent years, and overviews of systematic reviews have examined their effectiveness and implementation. But a care model only works if patients can walk through the door. For unemployed survivors, renters, and lower-income women, the barriers are financial and logistical as much as clinical, and programs that ignore that reality risk widening the very gaps they aim to close.

What emerges from this study is a portrait of survivorship that is deeply stratified by economics. Two women with the same diagnosis and the same prognosis can face radically different post-treatment trajectories depending on whether they own a home, hold a job, or earn more than $50,000 a year. As the survivor population grows, the public health imperative is to ensure that the years gained after cancer are years of monitored, continuous care for everyone, not a privilege distributed along lines of wealth. The Maryland data make the case with unusual clarity, and they give clinicians, health systems, and policymakers a concrete map of where the gaps lie and who falls through them.

Subject of Research: Socioeconomic disparities in healthcare utilization and access among female cancer survivors in Maryland

Article Title: Disparities in healthcare utilization and access by measures of economic stability among female cancer survivors in Maryland

Article References: Keno, L. S., Jin, M., Cohen, C. M., Visvanathan, K., & Connor, A. E. (2026). Disparities in healthcare utilization and access by measures of economic stability among female cancer survivors in Maryland. Supportive Care in Cancer, 34(10), Article 993. https://doi.org/10.1007/s00520-026-11239-z

Image Credits: AI Generated

DOI: 10.1007/s00520-026-11239-z

Keywords: cancer survivorship, healthcare utilization, health disparities, economic stability, access to care, Maryland BRFSS, financial toxicity, homeownership, unemployment, primary care, women's health, socioeconomic factors