Financial worry in different dimensions of cancer

From: Jones, Public Health Sciences Division

Financial hardship has been associated with cancer diagnoses and treatments; moreover, cancer survivors are likely to endure financial hardships after remission.  Financial hardship in people with cancer is a public health as well as clinical concern. Studies have documented its association with poor quality of life and mortality.  In past literature, financial hardship has been addressed as a unidimensional concept.  However, it is multidimensional in nature, including variables such as cost of care, bankruptcy, and financial stress. According to recent studies, financial hardship has two components: material hardship and psychological financial burden.  Material hardship includes late bill payments, taking out loans, and bankruptcy. Psychological financial burden includes financial worry – thoughts and feelings concerning financial problems.  Financial worry is the process of experiencing a financial shock, which can lead to financial anxiety.  Evaluating financial worry can improve cancer outcomes, it can identify patients at risk for financial burden before its occurrence to provide aid or prevention. It can also encourage those with cancer to employ financial coping mechanisms. Dr.  Salene Jones, Assistant Professor in the Public Health Sciences Division, explained the purpose of the study, “The idea for the study came from talking to patients. I realized scientists needed to examine the causes of financial worry and financial hardship more generally rather than focusing on patient level interventions. Paid sick leave was a barrier I heard multiple times. Therefore, I decided to assess how multiple employment factors could contribute to financial anxiety (or stop it).” The objective of the study was to understand the dimensions of financial worry in cancer, identify employment factors associated with financial worry, and evaluate financial worry with mental health and cost-related nonadherence in cancer.  The paper was published in the journal Psychooncology.

The data collected for the study was from the publicly available 2018 National Health Interview Survey (NHIS). This was the most recent dataset to include the financial worry variables.  Several regression models were utilized to examine the association of employment characteristics with financial worry. The data fit best using a three-factor model from the exploratory factor analyses and financial worry was therefore divided into three dimensions: healthcare, basic needs, and lifestyle.  Next, multiple linear regression models were run, one with each type of financial worry as the outcome. Also, two logistic regression models, one with depression symptoms and one with anxiety symptoms as the outcome. Another regression was run with cost-related non-adherence to medications as the outcome.

Employment factors such as earning an hourly wage were associated with more financial worry within each dimension. Paid sick leave was associated with less worry about basic needs. Participants with 25 employees and less at their jobs were not more likely to financially worry.  Participants who worried about affording their lifestyle had worse mental health than those who didn’t worry about their lifestyle. Healthcare cost worry was associated with anxiety and cost-related nonadherence.  Dr. Jones elaborated on the results, “This work starts to identify employer side and policy level factors that could help alleviate financial worry. Things like providing paid sick leave, more job security or higher wages could be helpful.” 

Graphical Representation of Figure 1 Results for the explanatory factor analysis of financial worry
Figure 1. Results for the explanatory factor analysis of financial worry Image from Dr. Salene Jones

People with cancer should be assessed for financial worry and material hardship. Participants who have trouble affording healthcare can be referred to financial aid sources to prevent non-adherence to cancer treatment.  Dr. Jones stated, “One interesting finding was that size of employer was unrelated to financial anxiety. Larger employers are subject to laws like the Americans with Disabilities Act and the Family and Medical Leave Act. Therefore, we need more research to figure out what employers are doing that helps cancer patients stay employed and how we can help the employers help patients and their families.”  

This research was supported by the Centers for Disease Control and Prevention

Fred Hutch/University of Washington/Seattle Children's Cancer Consortium member Salene M. Jones led this work.

Jones SM. Financial Worry in People with Cancer: Relationship to Employment and Outcomes. Psycho‐Oncology. 2022 Sep 15. doi/full/10.1002/pon.6034