Examining the role of financial worry in cancer survivorship

From the Jones and Newcomb Labs, Public Health Sciences Division

The National Cancer Institute website hosts a Dictionary of Cancer Terms, which defines over 9000 terms related to cancer and medicine in non-technical language. Among more esoteric terms like “athymic nude mouse” and “H and E staining,” the dictionary contains six entries that begin with the word “financial.” One of these is “financial hardship,” a term that describes patients’ perception of difficulties related to the cost of health care. Cancer patients are more likely to experience financial hardship than people without cancer, and financial hardship has been associated with worse outcomes in cancer patients. One aspect of financial hardship is financial worry, which describes fears and anxiety about the ability to pay for future medical care, basic needs, and living costs. Up to 70% of people with cancer experience financial worry, but research to examine its impacts on health behaviors has lagged behind.

In a new study published in the Journal of Cancer Survivorship, Dr. Salene Jones, an assistant professor in the Public Health Sciences Division at the Fred Hutch, led an effort to explore the association of financial worry with health behaviors in cancer survivors. “Most work on financial hardship after cancer has examined how financial hardship affects quality of life and mortality,” explained Dr. Jones. “There has been very little work on how it affects the ability of cancer survivors to take care of their health, including problematic substance use.”

A watercolor of a woman with a worried expression seated at a desk with a piggy bank and silver coins.
Financial worry is associated with anxiety, depression, decreased quality of life, and tobacco use among cancer patients. Image generated with DALL-E 2 software.

In this study, Dr. Jones and the team examined the effects of financial worry on a broad range of health behaviors, including the problematic use of tobacco, cannabis, alcohol, and prescription opioid medications. To replicate previous studies on financial hardship in cancer patients, they also examined the association of financial worry with depression and anxiety disorders and quality of life. The team recruited participants through the Surveillance, Epidemiology and End Results (SEER) Cancer Registry for the Puget Sound region. Over 1500 cancer patients, who had been diagnosed with cancer between 6 and 20 months prior to enrollment, participated in the study. Participants took an online survey that included questions on financial worry, problematic substance use including tobacco and alcohol, mental health, and quality of life. Based on the survey results, the researchers looked for the association of financial worry with each health indicator and outcome using multivariable regressions.

The authors found that financial worry was associated with tobacco use – specifically, being a current vs. never smoker – but not with the problematic use of other substances, which included cannabis, alcohol, and prescription drugs. Furthermore, financial worry was associated with positive screens for anxiety and depressive disorders, and with decreased mental and physical quality of life.

These results provide important insights to Dr. Jones for future research. “The biggest question is how much financial anxiety might impact tobacco use long term as well as quit attempts,” said Dr. Jones. “A longitudinal study would help identify the long-term impacts of financial anxiety. And another direction is whether financial hardship interventions can be combined with other treatments to improve health. It’s possible that addressing the whole person could help people be healthier and take better care of their health.”

This work was supported by a supplement to the Fred Hutch/University of Washington Cancer Consortium.

The Fred Hutch/University of Washington/Seattle Children’s Cancer Consortium members Drs. Salene Jones, Jaimee Heffner, and Stacey Cohen contributed to this work.

Jones SM, Ton M, Heffner JL, Malen RC, Cohen SA, and Newcomb PA. 2023. Association of financial worry with substance use, mental health, and quality of life in cancer patients. Journal of Cancer Survivorship.