Context. Few studies have examined the association between financial strain and quality of life outcomes in breast cancer. Objectives. To examine the association between financial strain and key elements of physical and emotional quality of life among women with breast cancer.Methods. Across three geographically diverse samples (census regions: Northeast ¼ 13.2%, Midwest ¼ 26.8%, South ¼ 35.5%, West ¼ 17.4%; international ¼ 7.1%), 309 women with a history of breast cancer completed online surveys including measures of financial strain, depression, anxiety, symptom burden, and perceived health. The third sample (N ¼ 134) also reported financial toxicity that specifically documents financial strain because of medical care costs. Primary analyses assessed the association between financial strain and measures of emotional and physical quality of life. Sensitivity analyses examined associations using the measure of financial toxicity. All analyses were controlled for key covariates.Results. Results showed that 37.5% of women experienced financial strain (Samples 1e3), varying from 12.1% among older, married, and college-educated women to 81.0% among women who were younger, unmarried, and lacked a college education. In addition, 26.1% reported treatment-specific financial toxicity (Sample 3). Financial strain was associated with more severe symptoms of depression (P < 0.001) and anxiety (P < 0.001) and worse physical symptom burden (P < 0.001) and perceived health (P < 0.001). Observed effects were sustained in sensitivity analyses using the financial toxicity measure.Conclusions. The present investigation illustrates the importance of financial strain in breast cancer. Healthcare systems are encouraged to expand interdisciplinary palliative and supportive care services that have the expertise necessary to help financially strained patients navigate the cancer care continuum.

The pretreatment serum lactate dehydrogenase level (LDH) was the single most important prognostic variable in 30 patients with diffuse histiocytic lymphoma treated between January 1973 and January 1977 with a poly-drug chemotherapy program called the cyclophosphamide L2 protocol at the Memorial Sloan-Kettering Cancer Center. A highly significant difference was found between the survival patterns of patients with LDH levels of 500 U or less and those with LDH levels greater than 500 U. (Two-year survival rates were 67% and 13%, respectively.) A similar trend was observed for 25 patients with diffuse, poorly differentiated lymphocytic lymphoma treated with the same protocol, although this difference was not statistically significant. (Corresponding two-year survival rates were 74% and 33%, respectively.) The association of LDH level with survival was evident even after adjustment for other factors of potential prognostic significance. Pretreatment serum LDH determinations may provide a useful means of stratifying patient populations when comparing treatment programs for advanced stage non-Hodgkin's lymphoma.

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109 Background: Approximately 4 out of 5 Americans are unfamiliar with palliative care, a significant barrier to utilization. Accordingly, providing patients with knowledge could empower them to seek palliative care. As a pilot investigation, the EMPOWER Study examined the impact of a psychoeducational intervention on patients’ preferences for palliative care. Methods: Participants were 581 patients with heterogeneous cancer diagnoses recruited through the NIH-sponsored ResearchMatch program. The study used a between-group pre-post design, completed in a single session via the Internet. Random assignment determined whether participants received psychoeducational information summarizing the results of the Temel et al. (2010) palliative care article, using a plain-language and graphical format. Participants completed measures of their health history, demographics, socioeconomic status (education level, financial strain, subjective financial standing), and depression symptom severity and completed a pre-post measure of preferences for palliative care. Results: Relative to controls, participants receiving the intervention experienced an increase in preferences for palliative care (p < .0001). The standardized mean difference in pre-post change was greater than a standard deviation in magnitude (Cohen’s d = 1.03), a “large” effect size by conventional standards. The intervention showed comparable effects across key patient subgroups, including patients of low socioeconomic status, patients living in low-access states, and patients with greater depression symptom severity. Conclusions: Providing patients with knowledge of recent research findings increased preferences for palliative cancer care. The next step is to develop psychoeducational interventions that are grounded in stakeholder input and incorporate a broader evidence base. This line of research has implications for empowering patients and their families to seek care that can improve quality of life.

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