Economic survivorship stress is associated with poor health-related quality of life among distressed survivors of hematopoietic stem cell transplantation

Abstract

Background: Hematopoietic stem cell transplantation is a demanding cancer treatment associated with enduring physical and psychological complications. Survivors' well-being may be further compromised by exposure to chronic stressors common to this population, including difficulties arising from costly medical care, changes in employment status, and health insurance coverage. Thus, we hypothesized that financial, employment, and insurance stressors (collectively referred to as economic survivorship stressors) would be associated with poorer health-related quality of life (HRQOL) among hematopoietic stem cell transplantation survivors.

Methods: Survivors (n = 181; M = 640 days post-transplant) completed the measures of study variables through mailed questionnaires and telephone interviews. Hierarchical regression analyses were conducted to test the hypothesized associations between economic survivorship stressors and HRQOL, and to examine whether social and situational factors interact with survivors' stress perceptions to predict HRQOL.

Results: Greater financial and employment stress were associated with poorer functioning across multiple HRQOL domains, even after controlling for the effects of possible confounding sociodemographic and medical variables. Insurance stress was not associated with HRQOL. Some associations were moderated by situational factors including timing of the current financial crisis and portion of the transplant paid for by health insurance.

Conclusions: Hematopoietic stem cell transplantation survivors can face serious economic challenges during recovery. Results suggest the value of viewing these challenges as chronic stressors capable of reducing survivors' mental and physical well-being. Identifying resources and skills that help survivors cope with these demands is an important goal for clinicians and researchers.

Figure 1

Timing of the financial crisis and financial stress interact to predict emotional well-being. Higher emotional well-being scores indicate better HRQOL.

Figure 2

Portion of the transplant paid by health insurance and financial stress interact to predict transplant-specific concerns. Higher transplant-specific concerns scores indicate better HRQOL.