Financial toxicity is more than costs of care: the relationship between employment and financial toxicity in long-term cancer survivors

Abstract

Purpose The aim of this study was to examine the relationship between employment and financial toxicity by examining the prevalence of, and factors associated with, financial toxicity among cancer survivors. Methods We conducted a secondary analysis of a sub-sample from the Dutch Patient Reported Outcomes Following Initial Treatment and Long-term Evaluation of Survivorship (PROFILES) registry. Descriptive statistics, bivariate analysis and logistic regression were used. Results A total of 2931 participants with diverse cancer types were included in the analysis with a mean age of 55 years (range 18 to 65). Nearly half (49%) of participants were employed at the time of the survey, and 22% reported financial toxicity. Those who were not employed were at greater risk of financial toxicity (27% vs 16%, p < 0.001), and this did not vary according to time since diagnosis. The odds of reporting financial toxicity were greater for participants who were male, younger, unmarried, with low education, low socioeconomic status, or without paid employment. Those with basal cell carcinoma had lower risk of financial toxicity, while those with haematological or colorectal cancer had highest risk of financial toxicity. Conclusions This research confirms that unemployment is significantly associated with financial toxicity and that those with limited financial resources are most at risk. Implications for cancer survivors Increased awareness of financial toxicity and its associated factors among clinicians may result in improved screening and appropriate referrals for support services. The implementation of effective multidisciplinary return to work interventions, as part of standard cancer survivorship care, may reduce financial toxicity among cancer survivors.

‘It was a big monetary cut’—A qualitative study on financial toxicity analysing patients’ experiences with cancer costs in Germany

“…We can confirm that income loss is a major cause of high short‐term or long‐term financial decline, as found in other studies (Arozullah et al, ; Bradley et al, ; Dean et al, ; Lauzier et al, ; Pearce et al, ). However, high medical costs, especially non‐refundable costs, can increase the financial impact of a cancer diagnosis.…”

“…Direct medical costs for hospitalisation and physician visits and increasing costs for cancer drugs have been found to have the strongest impact on financial toxicity in countries without universal health coverage (Carrera et al, 2018;Pisu, Henrikson, Banegas, & Yabroff, 2018;Zafar et al, 2013). The underlying reason for indirect costs is productivity loss, which results in lower income (Altice et al, 2017;Pearce et al, 2018). More than 30% of cancer patients do not return to work after receiving a cancer diagnosis (Mehnert, 2011).…”

Changes in internet use and wishes of cancer survivors: A comparison between 2005 and 2017

“…Societal changes (eg, in the area of employment status) may have driven this change. 21 The data from the current study demonstrate that this aspect has become especially important for young respondents.…”

Return to Work in Survivors of Human Papillomavirus–Associated Oropharyngeal Cancer: An Australian Experience

“…14 Unemployed cancer survivors are more likely to experience financial toxicity compared with employed cancer survivors, including psychological distress associated with finances. 15 Compared with other cancer types, survivors of HNC experience higher rates of unemployment. [16][17][18][19] To date, studies reporting RTW in HNC populations have largely focused on surgical cohorts or have had heterogeneous inclusion criteria, with limited relevance to HPV-associated OPC survivors who are younger and thus likely have a greater need to RTW.…”