Cancer‐related financial hardship among head and neck cancer survivors: Risk factors and associations with health‐related quality of life

Abstract

Objective Cancer survivors are susceptible to financial hardship. In head and neck cancer (HNC) survivors, we investigated (a) predictors for cancer‐related financial hardship and (b) associations between financial hardship and health‐related quality of life (HRQoL). Methods We conducted a cross‐sectional study in HNC survivors identified from the National Cancer Registry Ireland. HRQoL was based on the Functional Assessment for Cancer Therapy General (FACT‐G) plus Head and Neck Module (FACT‐HN). Objective cancer‐related financial hardship (financial stress) was assessed as household ability to make ends meet due to cancer and subjective financial hardship (financial strain) as feelings about household financial situation due to cancer. Modified Poisson regression was used to identify predictors for financial hardship. Bootstrap linear regression was used to estimate associations between hardship and FACT domain scores. Results Pre‐diagnosis retirement (relative risk [RR] 0.50, 95% confidence interval [CI] 0.37‐0.67), pre‐diagnosis financial stress (RR 1.85, 95% CI 1.58‐2.15), and treatment were significantly associated with objective financial hardship. Predictors of subjective financial hardship were similar: aged greater than or equal to 65 years, pre‐diagnosis financial stress, and treatment. Participants with objective financial hardship reported significantly lower physical (coefficient −3.45, 95% CI −4.39 to −2.44), emotional (−2.01, 95% CI −2.83 to −1.24), functional (−2.56, 95% CI −3.77 to −1.33) and HN‐specific HRQoL (−3.55, 95% CI −5.04 to −2.23). Physical, emotional, and functional HN‐specific HRQoL were also significantly lower in participants with subjective financial hardship. Conclusion Cancer‐related financial hardship is common and associated with worse HRQoL among HNC survivors. This supports the need for services and supports to address financial concerns among HNC survivors.

Medical financial hardship reported by Native Hawaiian and Pacific Islander cancer survivors compared with non‐Hispanic whites

“…Altice et al conducted a systematic review of studies that described financial hardship experienced by cancer survivors and categorized existing measures into 3 categories: 1) material conditions (out‐of‐pocket costs, productivity loss, medical debt, or bankruptcy), 2) psychological responses (such as distress or worry from hardship), and 3) coping behaviors (skipped medications) . Among the studies they reviewed as well as other studies published after the review, most examined material conditions, and fewer examined coping behaviors or psychological responses. In our study, we used a measure of MFH that encompasses all 3 domains and has been used in previous studies among cancer survivors …”

“…Financial hardship can lead to unfavorable health care seeking behaviors, which could result in worse health outcomes and quality of life. Most studies only investigated this relation in the general cancer survivor population . Hastert et al reported differential forms of financial hardship experienced by African American versus white cancer survivors and found that it was associated with differences in limiting care because of cost .…”

Cumulative financial stress as a potential risk factor for cancer-related fatigue among prostate cancer survivors

“…Recognition of financial hardship among cancer survivors is growing [19][20][21][22][23]. Survivors may be vulnerable to material financial hardship (henceforth financial stress) [24] due to outof-pocket costs as a result of the cancer diagnosis (e.g.…”

“…for medical care, supportive medications, travel to appointments) and lost income because of work absence during cancer treatment and rehabilitation [19]. Such financial stress appears particularly common in survivors with low income or financial stress before diagnosis [25][26][27][28] and has been associated with poor psychological well-being and worse quality of life (QoL) in a range of cancers [23,26,[29][30][31]. These findings have led to a recent call to increase knowledge of the relationship between financial stress and cancer-related symptoms or side effects, particularly those with physical manifestations [32]; better understanding of this could inform development and targeting of interventions among survivors.…”

Observational non-randomised controlled evaluation of the effectiveness of cancer counselling centres: a study protocol

“…A cancer diagnosis and its treatment influence the psychological well-being of the person diagnosed and may also have an effect on the relatives’ well-being 1–5. Moreover, evidence exists that a cancer diagnosis can also lead to occupational and financial hazards 6–8…”