Financial Distress and Its Associations With Physical and Emotional Symptoms and Quality of Life Among Advanced Cancer Patients. (23rd July 2015)

• Record Type: Journal Article
• Authors: Delgado-Guay, Marvin; Ferrer, Jeanette; Rieber, Alyssa G.; Rhondali, Wadih; Tayjasanant, Supakarn; Ochoa, Jewel; Cantu, Hilda; Chisholm, Gary; Williams, Janet; Frisbee-Hume, Susan; Bruera, Eduardo
• Is Part Of: Oncologist. Volume 20:Number 9(2015)
• Page Start: 1092
• Page End: 1098
• Publication Date: 2015-07-23
• Subjects: Financial distress -- Advanced cancer -- Quality of life; Oncology -- Periodicals; Tumors -- Periodicals; Cancérologie -- Périodiques; Tumeurs -- Périodiques; Oncology; Tumors; Neoplasms; Electronic journals; Periodicals; Periodicals; 616.994
• DOI: 10.1634/theoncologist.2015-0026
• Languages: English
• ISSNs: 1083-7159

Abstract

Abstract: Objective: There are limited data on the effects of financial distress (FD) on overall suffering and quality of life (QOL) of patients with advanced cancer (AdCa). In this cross-sectional study, we examined the frequency of FD and its correlates in AdCa. Patients and Methods: We interviewed 149 patients, 77 at a comprehensive cancer center (CCC) and 72 at a general public hospital (GPH). AdCa completed a self-rated FD (subjective experience of distress attributed to financial problems) numeric rating scale (0 = best, 10 = worst) and validated questionnaires assessing symptoms (Edmonton Symptom Assessment System [ESAS]), psychosocial distress (Hospital Anxiety and Depression Scale [HADS]), and QOL (Functional Assessment of Cancer Therapy-General [FACT-G]). Results: The patients' median age was 60 years (95% confidence interval [CI]: 58.6–61.5 years); 74 (50%) were female; 48 of 77 at CCC (62%) versus 13 of 72 at GPH (18%) were white; 21 of 77 (27%) versus 32 of 72 (38%) at CCC and GPH, respectively, were black; and 7 of 77 (9%) versus 27 of 72 (38%) at CCC and GPH, respectively, were Hispanic ( p < .0001). FD was present in 65 of 75 at CCC (86%; 95% CI: 76%–93%) versus 65 of 72 at GPH (90%; 95% CI: 81%–96%; p = .45). The median intensity of FD at CCC and GPH was 4 (interquartile range [IQR]: 1–7) versus 8 (IQR: 3–10), respectively ( p = .0003). FD was reported as more severe than physical distress, distress about physical functioning, social/family distress, and emotional distress by 45 (30%), 46 (31%), 64 (43%), and 55 (37%) AdCa, respectively (all significantly worse for patients at GPH) ( p < .05). AdCa reported that FD was affecting their general well-being (0 = not at all, 10 = very much) with a median score of 5 (IQR: 1–8). FD correlated (Spearman correlation) with FACT-G ( r = −0.23, p = .0057); HADS-anxiety ( r = .27, p = .0014), ESAS-anxiety ( r = .2, p = .0151), and ESAS-depression ( r = .18, p = .0336). Conclusion: FD was very frequent in both groups, but median intensity was double among GPH patients. More than 30% of AdCa rated FD to be more severe than physical, family, and emotional distress. More research is needed to better characterize FD and its correlates in AdCa and possible interventions. Implications for Practice: Financial distress is an important and common factor contributing to the suffering of advanced cancer patients and their caregivers. It should be suspected in patients with persistent, refractory symptom expression. Early identification, measurement, and documentation will allow clinical teams to develop interventions to improve financial distress and its impact on quality of life of advanced cancer patients. Abstract : The association between financial distress and quality of life in patients with advanced cancer treated at a comprehensive cancer center were compared with that of patients treated at a general hospital, as was the frequency of financial distress and its correlates. Financial distress occurred very frequently in both groups, but the median intensity of financial distress among patients treated at the general public hospital was significantly greater than that of patients treated at the cancer center.