Date of Award

January 2014

Document Type

Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Anees Chagpar

Subject Area(s)

Medicine

Abstract

ABSTRACT:

Purpose: Little is known about the relationship between the financial burden of cancer and the physical and emotional health of cancer survivors. We examined the association between financial problems caused by cancer and reported quality of life in two samples of cancer patients.

Patients and Methods: Data from the 2010 National Health Interview Survey (NHIS) were analyzed. A multivariate regression model was used to examine the relationship between the degree to which cancer caused financial problems and the patients' reported quality of life.

In a separate study, a cross-sectional survey was administered at a large academic breast center. Patients who had received a diagnosis of breast cancer between 6 and 18 months prior were eligible. Patients who qualified were invited to complete a survey including sociodemographic factors, and questions pertaining to their perceived quality of life and the financial burden of their cancer treatment. These data were correlated with tumor and treatment factors. Non-parametric statistical analyses were conducted using SPSS.

Results: In the NHIS data, of 2108 cancer patients who answered the survey question, "To what degree has cancer caused financial problems for you and your family?", 8.6% reported "a lot", while 69.6% reported "not at all". Patients reporting "a lot" of financial problems due to cancer were more likely to rate their physical health (18.6% vs. 4.3%, p<0.001), mental health (8.3% vs. 1.8%, p<0.001), and satisfaction with social activities and relationships (11.8% vs. 3.6%, p<0.001) to be poor compared to those with no financial hardship. On multivariate analysis controlling for all of the significant covariates on bivariate analysis, the degree to which cancer caused financial problems was the strongest independent predictor of quality of life. Patients who reported that cancer caused "a lot" of financial problems were four times less likely to rate their quality of life as "excellent", "very good", or "good" (OR=0.24; 95% CI: 0.14-0.40, p<0.001).

In the Yale Breast Center study, a total of 72 patients completed the survey. The mean age was 60 and mean tumor size was 2.3cm. When asked to what degree cancer caused financial problems, 18.1% responded "a lot", 12.5% "some", 18.1% "a little", and 44.4% "not at all". The majority (84.7%) self-reported their QOL to be "excellent", "very good", or "good", while 8.4% answered "fair" or "poor". On bivariate analysis, insurance status (p=0.029), education (p=0.013), family income (p=0.029), treatment history (chemotherapy, endocrine therapy, neither, or both) (p<0.001), and ER receptor status (p=0.037) were all significantly associated with the degree to which cancer caused financial problems.

Conclusion: Increased financial burden due to cancer was the strongest independent predictor of poor quality of life among cancer survivors in a nationwide population-based survey. We studied this relationship in a population of breast cancer patients at an academic center. Patients with hormone receptor-negative disease were more likely to report a large degree of financial problems. These patients represent a subset of patients with a poorer prognosis requiring more intensive therapy, These data support the need for increased clinician awareness of financial distress due to cancer, which may preferentially impact subsets of breast cancer patients.

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