Researchers have discovered that the financial impact of an individual’s cancer diagnosis may also impact a partner’s health-related quality of life, according to a new study published by Ghazal et al in JAMA Network Open.
“When you think of key developmental milestones young adults expect to achieve, they are driven by money: completing education, establishing employment, cultivating romantic relationships, [and] starting a family. All of these milestones impact becoming financially independent, and all are susceptible to disruption. And of course, a cancer diagnosis is a major disruption,” emphasized senior study author Christine M. Veenstra, MD, MSHP, Associate Professor of Medical Oncology at Michigan Medicine the University of Michigan.
“We know that financial toxicity or hardship is a significant effect of cancer and its treatment and is associated with poor health issues for patients and survivors. Financial toxicity extends to caregivers or partners too. We wanted to understand how that financial toxicity affects the caregiver’s health outcomes—such as anxiety and depressive symptoms, fatigue, overall quality of life, or well-being,” explained lead study author Lauren V. Ghazal, PhD, MS, FNP-BC, a postdoctoral research fellow in Cancer Care Delivery Research as well as Adolescent and Young Adult Cancer Research in the Department of Systems, Populations, and Leadership at the School of Nursing and the Rogel Cancer Center at the University of Michigan. “It is important to examine the full effect of financial toxicity on a household in order to develop multilevel interventions that center the patients,” she added.
Survey Methods and Results
In the new study, researchers surveyed patients who had been treated from 1 to 5 years prior for stage III colorectal cancer. They also surveyed the patients’ spouses, domestic partners, or significant others who lived in the same household; they received 307 responses from patient-partner pairs. Among the survey’s topics were:
- Financial burden, such as cutting down on spending or missing bill payments
- Debt, including unpaid bills, bank loans, or borrowed money from family or friends
- Financial worry, focused on current or future financial problems from the cancer treatment.
Patients and their partners were further asked about health-related qualify of life factors—including physical function, anxiety, depression, fatigue, sleep disturbance, social roles and activities, and pain.
Among the partners who worked full- or part-time when the patient was diagnosed, 39% of them reported missing between 1 week and 1 month of work, and 38% of them said they lost income due to their partner’s cancer. Almost two-thirds of the partners reported experiencing financial burdens requiring them to cut down on expenses, activities, food, or clothes or use savings. About one-third of the partners had high levels of financial worry—which increased the more they lost income or missed work. Further, 29% of the partners reported experiencing debt related to the cancer diagnosis and treatment.
Across the seven health-related quality-of-life issues, financial toxicity was consistently associated with worse quality-of-life factors. The partners described financial toxicity as primarily related to health insurance and employment status; but they also reported extra emotional spending, disrupted social lives, a need to ask family and friends for help with medical expenses, and worry over what could have been if they hadn’t had insurance. Additionally, younger partners were significantly more likely to report financial burden and debt—which the researchers found to be striking, considering rates of colorectal cancer among younger adults have increased in recent years.
Conclusions
“As we see colorectal cancer becoming more common at younger ages, it is imperative we assess for financial hardship among patients and their partners and connect them with services and support both within and outside the hospital setting,” Dr. Veenstra recommended.
The researchers concluded that they hope to conduct future studies analyzing the impact of financial toxicity on patients and partners together, and identifying employer-level considerations or other interventions that could help mitigate financial toxicity among patients and their partners.
Disclosure: The research in this study was funded by the National Cancer Institute and the U.S. Centers for Disease Control and Prevention. The study was additionally supported by the Rogel Cancer Center’s Cancer Data Science Shared Resource. For full disclosures of the study authors, visit jamanetwork.com.
