Relationships Among Financial Distress, Emotional Distress, and Overall Distress in Insured Patients With Cancer

Abstract

Purpose: Recent studies have demonstrated increasing rates of financial toxicities and emotional distress related to cancer treatment. This study assessed and characterized the relationships among financial distress, emotional symptoms, and overall distress in patients with cancer.

Methods: A cross-sectional sample of patients with cancer who visited our outpatient medical oncology and psychiatry clinics completed a pen-and-paper survey. The survey assessed demographics; cost concerns; and financial, emotional, and overall distress.

Results: One hundred twenty insured patients completed the survey. Sixty-five percent reported clinically significant overall distress scores, with the same percentage reporting at least one emotional problem (worry, anxiety, depression, etc). Twenty-nine percent scored in the range of high to overwhelming financial distress. By using structural equation modeling, we found that financial distress was associated with overall distress. This association was both direct (accounting for 76% of the effect) and indirect (accounting for 24% of the effect) via mediation by emotional distress.

Conclusion: This cohort of patients with cancer reported significant levels of emotional distress, financial distress, and overall distress. These factors were interrelated, with both financial and emotional distress contributing to overall distress. Interventions targeted at alleviating financial distress may help to decrease levels of overall distress.

FIG 1.

InCharge Financial Distress/Financial Well-being average scores. Scores represent the full decile (ie, 1 = all possible scores from 1.0 to 1.99), with the exception of 10, which represents an average score of exactly 10.0. Normative descriptive terminology for interpreting InCharge scores includes modifiers related to both financial distress and financial well-being (ie, overwhelming financial distress/lowest financial well-being); terminology has been truncated to include only financial distress modifiers.

FIG 2.

(A) Association between financial distress and overall distress. (B) Emotional distress mediates the association between financial distress and overall distress (P = .005). Financial distress was measured using the InCharge Financial Distress/Financial Well-being scale, where scores range from 1.0 to 10.0 and a lower score indicates greater financial distress. Overall distress was measured using the National Comprehensive Cancer Center Distress Thermometer, which is a screening tool for distress with scores that range from 0 (no distress) to 10 (most distress). Emotional distress was measured by summing the number of emotional problems indicated by each participant on the Problem List portion of the Distress Thermometer. *P = .008; **P < .001.