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. 2015 Mar;11(2):145-50.
doi: 10.1200/JOP.2014.001542. Epub 2014 Dec 16.

Population-based assessment of cancer survivors' financial burden and quality of life: a prospective cohort study

S Yousuf Zafar  1 , Rebecca B McNeil  2 , Catherine M Thomas  2 , Christopher S Lathan  2 , John Z Ayanian  2 , Dawn Provenzale  2
Affiliations

Population-based assessment of cancer survivors' financial burden and quality of life: a prospective cohort study

S Yousuf Zafar et al. J Oncol Pract. 2015 Mar.

Abstract

Purpose: The impact of financial burden among patients with cancer has not yet been measured in a way that accounts for inter-relationships between quality of life, perceived quality of care, disease status, and sociodemographic characteristics.

Patients and methods: In a national, prospective, observational, population- and health care systems-based cohort study, patients with colorectal or lung cancer were enrolled from 2003 to 2006 within 3 months of diagnosis. For this analysis, surviving patients who were either disease free or had advanced disease were resurveyed a median 7.3 years from diagnosis. Structural equation modeling was used to investigate relationships between financial burden, quality of life, perceived quality of care, and sociodemographic characteristics.

Results: Among 1,000 participants enrolled from five geographic regions, five integrated health care systems, or 15 Veterans Administration Hospitals, 89% (n = 889) were cancer free, and 11% (n = 111) had advanced cancer. Overall, 48% (n = 482) reported difficulties living on their household income, and 41% (n = 396) believed their health care to be "excellent." High financial burden was associated with lower household income (adjusted odds ratio [OR] = 0.61 per $20k per year, P < .001) and younger age (adjusted OR = 0.63 per 10 years; P < .001). High financial burden was also associated with poorer quality of life (adjusted beta = -0.06 per burden category; P < .001). Better quality of life was associated with fewer perceptions of poorer quality of care (adjusted OR = 0.85 per 0.10 EuroQol units; P < .001).

Conclusion: Financial burden is prevalent among cancer survivors and is related to patients' health-related quality of life. Future studies should consider interventions to improve patient education and engagement with regard to financial burden.

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Figures

Figure 1.
Figure 1.
Simplified representation of the path model focusing on primary outcomes only. OR, odds ratio; QoL, quality of life.
See this image and copyright information in PMC

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