Psychobehavioral risk factors for financial hardship and poor functional outcomes in survivors of multiple primary cancers

Abstract

Objective Survivors of multiple primary cancers (MPC) are at increased risk for poor health outcomes compared with survivors of single cancers. Using an adapted psychobehavioral stress‐response model, the study purpose was to identify pathways and individual risk factors associated with poor health outcomes in adults with MPC. Methods Adult MPC survivors (N = 211) with first cancers (stages I‐III) diagnosed within 1 to 10 years were recruited via tumor registry. Employing a cross‐sectional design, established questionnaires were used to operationalize patient characteristics and theoretical constructs including perceived stress, psychological and behavioral responses, financial hardship, social role function, and physical health. Disease and treatment data were obtained via registry and medical records. Structural equation modeling (SEM) was performed to fit, test, and modify the hypothesized psychobehavioral model. Results Following measurement model refinement, an SEM linking self‐management behaviors, distress, financial hardship, and functional health demonstrated a good fit: χ2 (200, N = 206) = 332.06, P < .01; Tucker‐Lewis index (TLI) = .95, comparative fit index (CFI) = .96, standardized root mean residual (SRMR) = .06, root‐mean‐square error of approximation (RMSEA) = .06. Less use of self‐management behaviors predicted higher distress which, in turn, predicted higher financial hardship; higher distress and financial hardship predicted poorer functional health. Several sociodemographic and personal factors predicted self‐management behaviors and distress. Conclusions The hypothesized stress‐response model was partially supported. Data supported pathways among self‐management behaviors, distress, financial hardship, and functional health. Self‐management and distress may represent modifiable intervention targets for MPC survivors. High body mass index (BMI), less education, greater neuroticism, and lower social support were associated with less use of self‐management behaviors and higher distress and should be further evaluated as potential markers of vulnerability.

Financial Hardship and Quality of Life Among Patients With Advanced Cancer Receiving Outpatient Palliative Care

“…The dimensions that were found to be significantly associated with FH are also consistent with prior literature QOL constructs such as role changes, pain, and emotional/ psychological well-being. 12,44,45 New literature 40 suggests that a COST cutoff score of 17.5, which is similar to our median sample score of 16.8, may provide acceptable sensitivity and specificity to predict QOL as measured by the Functional Assessment of Cancer Therapy-General. While self-reported race was a variable included in model testing (that did not produce significant associations in multivariate testing), we recognize that race is a social construct, not a biological variable, and suggest that future studies continue to explicitly measure and examine root causes underpinning health and well-being, such as systemic racism.…”

“…8 Financial hardship has been associated with marked negative outcomes, including increased symptom burden, decreased quality of life (QOL), bankruptcy, and increased mortality. [9][10][11][12][13] Despite the known negative influence of FH on health and QOL, studies have demonstrated that adequate patient-provider communication about FH does not consistently occur in the clinical setting, 14,15 which may contribute to increased symptom burden and suffering.…”

A systematic review of financial toxicity among cancer patients in China

“…Several modifiable factors, including provider-patient discussions about costs, social support, and perceived stress, may affect FT in cancer patients. 18,75,76 Well-designed studies are warranted to examine the association between these factors and FT in cancer patients.…”

Impact of Obesity on Quality of Life, Psychological Distress, and Coping on Patients with Colon Cancer

“…Obesity has been linked to a proinflammatory state that causes nociceptive hypersensitivity with a heightened perception of pain [19,20] and psychological distress [21,22]. Betcher et al have correlated a higher BMI, lower level of education, greater neuroticism, and less social support with self-controlled behavior and greater anguish [22]. Obesity has been associated with increased depression that fosters weight gain [23].…”