Financial Strain and Physical and Emotional Quality of Life in Breast Cancer

Abstract

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.

A Conceptual and Operational Review of the Negative Financial Health Terminology and Constructs

“…Financial strain was discussed in 11 studies out of 37 and definitions were provided in 7 studies out of 11. Definitions ranged from "Composed of the cognitive, emotional, and behavioral response to the experience of financial hardship" (Aldana & Liljenquist 1998); "Subjective experience of his/her financial situation" (Grossi, Perski, Lundberg, & Soares, 2001); -perceived financial inadequacy‖ (Glei, Goldman, and Weinstein, 2018); -Difficulty meeting financial needs and obligations‖ (Kalkhoran, Berkowitz, Rigotti, & Bagget,t 2018); -Lacking the financial resources necessary to meet basic needs‖ (Perry et al, 2019); and -self-assessed or perceived financial difficulties and unemployment circumstances‖ (Zheng et al, 2019).…”

Time to add screening for financial hardship as a quality measure?

“…[27][28][29][30] Patients experiencing financial hardship are also more likely to forgo mental health care, physician visits, and other medical care. 28 These patients experience more symptom burden and diminished quality of life, [31][32][33] and they may be at greater risk for early mortality. 34 Initial evidence from a pilot study suggests that financial navigation programs can reduce anxiety about costs, even if financial burden does not change.…”

Financial distress among breast cancer survivors

“…, medications, supplies, co-payments, transportation, parking) and reduced income because of missing work, loss of employment, or unplanned retirement. 5 Cancer survivors may be vulnerable to out-of-pocket expenses due to unemployment, medical debt, and diminished consumer credit. 6 , 7 This is especially true for women, young patients, racial and ethnic minorities, persons who have low income or financial illiteracy, and those without health insurance.…”