Financial Distress and Its Associations With Physical and Emotional Symptoms and Quality of Life Among Advanced Cancer Patients

Abstract

Background and Aims Financial problems are frequent and severe for AdCa and caregivers. There is limited data on the effects of FD on overall suffering and quality of life(QOL) of AdCa. In this prospective cross sectional study, we examined the frequency of FD and its correlates in AdCa. Methods We interviewed 149 AdCa, 77 at a Comprehensive Cancer Center(CCC) and 72 at a General Public Hospital(GPH). AdCa completed self-rated FD(subjective experience of distress attributed to financial problems) numeric rating scale(0=best, 10=worst) and validated questionnaires assessing symptoms(ESAS), psychosocial-distress(HADS), and QOL(FACT-G). Results Median age (Interquartile range:IQR): 60 years(55-65). 74/149 (50% ) were female. 78/149 (52% ) were married. 48/77 (62% ) at CCC vs. 13/ 72(18% ) at GPH were white (p<0.0001); 21/77 (27% ) vs. 32/72 (38% ) were African American (p<0.0001), and 7/77 (9% ) vs. 27/72 (38% ) were Hispanics (p<0.0001). 44/77 (58% ) at CCC vs. 14/72 (19% ) at GPH had college-education and an advanced-degree(p<0.0001). The median (IQR) current-income was $3000 ($1,400-$7,000) for CCC vs. $940 ($350-$1,300) at GPH, p=0.0017. FD was present in 65/75 [86% (95% CI=76-93% )] at CCC vs. 65/72 [90% (81-96% )] p=0.45. However the median-intensity of FD (IQR) at CCC was 4(1-7) vs. 8(3-10), p=0.0003. FD was reported as more severe than physicaldistress, distress about physical-functioning, social/family distress and emotional distress by 45 (31% ), 46 (32% ), 64 (43% ), and 55 (37% ) AdCa respectively (all significantly worse for GPH). AdCa reported that FD was affecting their general-well-being (0=not at all, 10=very much) with a median (IQR) of 5(1-8). Spearman-Correlation of FD with FACTG( r=-0.23, p=0.005); HADS-Anxiety(r=0.27, p=0.001), ESAS Anxiety( r=0.2, p=0.01), and ESAS-depression(r=0.18 p=0.03). Conclusions FD was very frequent in both groups but intensity was double among GPH patients. FD was associated with worse anxiety, depression and poor-QOL. More research is warranted.