Skip to main content

Advertisement

SpringerLink
Log in

Pre-diagnosis employment status and financial circumstances predict cancer-related financial stress and strain among breast and prostate cancer survivors

  • Original Article
  • Published:
Supportive Care in Cancer Aims and scope Submit manuscript

Abstract

Purpose

Cancer may have a significant financial impact on patients, but the characteristics that predispose patients to cancer-related financial hardship are poorly understood. We investigated factors associated with cancer-related financial stress and strain in breast and prostate cancer survivors in Ireland, which has a complex mixed public-private healthcare system.

Methods

Postal questionnaires were distributed to 1373 people diagnosed with cancer 3–24 months previously identified from the National Cancer Registry Ireland. Outcomes were cancer-related financial stress (impact of cancer diagnosis on household ability to make ends meet) and financial strain (concerns about household financial situation since cancer diagnosis). Modified Poisson regression was used to estimate relative risks (RR) for factors associated with cancer-related financial stress and strain.

Results

Seven hundred forty survivors participated (response rate = 54 %). Of the respondents, 48 % reported cancer-related financial stress and 32 % cancer-related financial strain. Compared to those employed at diagnosis, risk of cancer-related financial stress was significantly lower in those not working (RR = 0.71, 95 % CI 0.58–0.86) or retired (RR = 0.48, 95 % CI 0.34–0.68). It was significantly higher in those who had dependents; experienced financial stress pre-diagnosis; had a mortgage/personal loans; had higher direct medical out-of-pocket costs; and had increased household bills post-diagnosis. For cancer-related financial strain, significant associations were found with dependents, pre-diagnosis employment status and pre-diagnosis financial stress; risk was lower in those with higher direct medical out-of-pocket costs.

Conclusions

Cancer-related financial stress and strain are common. Pre-diagnosis employment status and financial circumstances are important predictors of post-diagnosis financial wellbeing. These findings could inform development of tools to identify patients/survivors most in need of financial advice and support.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Longo CJ, Deber R, Fitch M, Williams AP, D’Souza D (2007) An examination of cancer patients’ monthly’out-of-pocket’ costs in Ontaria, Canada. Eur J Cancer Care 16:500–507

    Article  CAS  Google Scholar 

  2. Lauzier S, Maunsell E, Drolet M, Coyle D, Hebert-Croteau N, Brisson J, Masse B, Abdous B, Robidoux A, Roberts J (2008) Wage losses in the year after breast cancer: extent and determinants among Canadian women. J Natl Canser Inst 100:332

    Google Scholar 

  3. Pisu M, Azuero A, McNees P, Burkhardt J, Benz R, Meneses K (2010) The out of pocket cost of breast cancer survivors: a review. J Cancer Surviv 4:202–209

    Article  PubMed  PubMed Central  Google Scholar 

  4. Lauzier S, Levesque P, Drolet M, Coyle D, Brisson J, Mâsse B, Robidoux A, Robert J, Maunsell E (2011) Out-of-pocket costs for accessing adjuvant radiotherapy among Canadian women with breast cancer. J Clin Oncol 29:4007–4013

    Article  PubMed  Google Scholar 

  5. Longo CJ, Bereza BG (2011) A comparative analysis of monthly out-of-pocket costs for patients with breast cancer as compared with other common cancers in Ontario, Canada. Curr Oncol 18:e1–e8

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  6. Housser E, Mathews M, Lemessurier J, Young S, Hawboldt J, West R (2013) Responses by breast and prostate cancer patients to out-of-pocket costs in Newfoundland and Labrador. Curr Oncol 20:158–165

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  7. Lauzier S, Levesque P, Mondor M, Drolet M, Coyle D, Brisson J, Masse B, Provencher L, Robidoux A, Maunsell E (2013) Out-of-pocket costs in the year after early breast cancer among Canadian women and spouses. J Natl Cancer Inst 105:280–292

    Article  PubMed  Google Scholar 

  8. Timmons A, Gooberman-Hill R, Sharp L (2013) The multidimensional nature of the financial and economic burden of a cancer diagnosis on patients and their families: qualitative findings from a country with a mixed public-private healthcare system. Support Care Cancer 21:107–117

    Article  PubMed  Google Scholar 

  9. Longo CJ, Fitch M, Deber RB, Williams AP (2006) Financial and family burden associated with cancer treatment in Ontario, Canada. Support Care Cancer 14:1077–1085

    Article  PubMed  Google Scholar 

  10. Pisu M, Azuero A, Meneses K, Burkhardt J, McNees P (2011) Out of pocket cost comparison between Caucasian and minority breast cancer survivors in the Breast Cancer Education Intervention (BCEI). Breast Cancer Res Treat 127:521–529

    Article  PubMed  PubMed Central  Google Scholar 

  11. de Oliveira C, Bremner KE, Ni A, Alibhai SM, Laporte A, Krahn MD (2014) Patient time and out-of-pocket costs for long-term prostate cancer survivors in Ontario, Canada. J Cancer Surviv 8:9–20

    Article  PubMed  Google Scholar 

  12. Bradley CJ (2012) Financial hardship: a consequence of survivorship? J Clin Oncol 30:1579–1580

    Article  PubMed  Google Scholar 

  13. de Souza JA, Wong YN (2013) Financial distress in cancer patients. J Med Person 11:10.1007

    Article  Google Scholar 

  14. Valtorta NK, Hanratty B (2013) Socioeconomic variation in the financial consequences of ill health for older people with chronic diseases: a systematic review. Maturitas 74:313–333

    Article  PubMed  Google Scholar 

  15. Kent EE, Forsythe LP, Yabroff KR, Weaver KE, de Moor JS, Rodriguez JL, Rowland JH (2013) Are survivors who report cancer-related financial problems more likely to forgo or delay medical care? Cancer 119:3710–3717

    Article  PubMed  PubMed Central  Google Scholar 

  16. Zucca A, Boyes A, Newling G, Hall A, Girgis A (2011) Travelling all over the countryside: travel-related burden and financial difficulties reported by cancer patients in New South Wales and Victoria. Aust J Rural Health 19:298–305

    Article  PubMed  Google Scholar 

  17. Shankaran V, Jolly S, Blough D, Ramsey SD (2012) Risk factors for financial hardship in patients receiving adjuvant chemotherapy for colon cancer: a population-based exploratory analysis. J Clin Oncol 30:1608–1614

    Article  PubMed  Google Scholar 

  18. Francoeur RB (2005) Cumulative financial stress and strain in palliative radiation outpatients: the role of age and disability. Acta Oncol 44:369–381

    Article  PubMed  PubMed Central  Google Scholar 

  19. Hanratty B, Holland P, Jacoby A, Whitehead M (2007) Financial stress and strain associated with terminal cancer-a review of the evidence. Palliat Med 21:595–607

    Article  PubMed  Google Scholar 

  20. Lipscomb J, Gotay CC, Snyder CF (2007) Patient-reported outcomes in cancer: a review of recent research and policy initiatives. CA Cancer J Clin 57:278–300

    Article  PubMed  Google Scholar 

  21. Maddams J, Brewster D, Gavin A, Steward J, Elliott J, Utley M, Møller H (2009) Cancer prevalence in the United Kingdom: estimates for 2008. Br J Cancer 101:541–547

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  22. Siegel R, DeSantis C, Virgo K, Stein K, Mariotto A, Smith T, Cooper D, Gansler T, Lerro C, Fedewa S, Lin C, Leach C, Cannady RS, Cho H, Scoppa S, Hachey M, Kirch R, Jemal A, Ward E (2012) Cancer treatment and survivorship statistics, 2012. CA Cancer J Clin 62:220–241

    Article  PubMed  Google Scholar 

  23. Sharp L, Deady S, Gallagher P, Molcho M, Pearce A, Thomas AA, Timmons A, Comber H (2014) The magnitude and characteristics of the population of cancer survivors: using population-based estimates of cancer prevalence to inform service planning for survivorship care. BMC Cancer 14:767

    Article  PubMed  PubMed Central  Google Scholar 

  24. Smith S, Normand C (2011) Equity in health care: the Irish perspective. Health Econ Policy Law 6:205–217

    Article  PubMed  Google Scholar 

  25. Timmons A, Gooberman-Hill R, Sharp L (2013) “It’s a time in your life when you are most vulnerable”: a qualitative exploration of the financial impact of a cancer diagnosis and implications for financial protection in health. PLoS One 8(11):1–11

    Article  CAS  Google Scholar 

  26. McDevitt J, Sharp L, MacDonald D, Dwane F, Comber H (2013) Factors affecting receipt of a medical card in a cohort of colorectal cancer patients, 2002–2006. Ir Med J 106:110–113

    PubMed  CAS  Google Scholar 

  27. Sharp L, Timmons A (2010) The financial impact of a cancer diagnosis. National Cancer Registry Ireland. Available at URL: http://www.ncri.ie/pubs/pubfiles/Financial%20impact%20of%20a%20cancer%20diagnosis.pdf. [Accessed 22 Dec 2014]

  28. O’Brien K, Comber H, Sharp L (2014) Completeness of case ascertainment at the Irish National Cancer Registry. Ir J Med Sci 183(2):219–224

    Article  PubMed  Google Scholar 

  29. Zou G (2004) A modified Poisson regression approach to prospective studies with binary data. Am J Epidemiol 159:702–706

    Article  PubMed  Google Scholar 

  30. Organisation for Economic Cooperation and Development Data. Household accounts. Household disposable income. Organisation for Economic Cooperation and Development. Available at URL: http://data.oecd.org/hha/household-disposable-income.htm [Accessed 22 Dec 2014]

  31. Pukkala E, Weiderpass E (1999) Time trends in socio-economic differences in incidence rates of cancers of the breast and female genital organs (Finland, 1971–1995). Int J Cancer 81:56–61

    Article  PubMed  CAS  Google Scholar 

  32. National Cancer Intelligence Network Cancer Incidence by Deprivation England, 1995–2004. Available at URL: http://www.ncin.org.uk/analyses/NCIN_Incidence_by_Deprivation_95_04.pdf 2009. [Accessed 22 Dec 2014]

  33. Azzani M, Roslani AC, Su TT (2015) The perceived cancer-related financial hardship among patients and their families: a systematic review. Support Care Cancer 23:889–898

    Article  PubMed  Google Scholar 

  34. Zafar SY, Peppercorn JM, Schrag D, Taylor DH, Goetzinger AM, Zhong X, Abernethy AP (2013) The financial toxicity of cancer treatment: a pilot study assessing out-of-pocket expenses and the insured cancer patient’s experience. Oncologist 18:381–390

    Article  PubMed  PubMed Central  Google Scholar 

  35. Carp F, Carp A (1982) Test of a model of domain satisfaction and well-being. Equity considerations. Res Aging 4:503–522

    Article  Google Scholar 

  36. Fletcher C, Lorenz F (1985) Structural influences on the relationship between objective and subjective indicators of economic well-being. Soc Indic Res 16:333–345

    Article  Google Scholar 

  37. Moore KA (1999) Breast cancer patients’ out-of-pocket expenses. Cancer Nurs 22:389–396

    Article  PubMed  CAS  Google Scholar 

  38. Arozullah AM, Calhoun EA, Wolf M, Finley DK, Fitzner KA, Heckinger EA, Gorby NS, Schumock GT, Bennett CL (2004) The financial burden of cancer: estimates from a study of insured women with breast cancer. J Support Oncol 2:271–278

    PubMed  Google Scholar 

  39. Baider L, Andritsch E, Uziely B, Ever-Hadani P, Goldzweig G, Hoffman G, Samonigg H (2003) Do different cultural settings affect the psychological distress of women with breast cancer? A randomized study. Eur J Cancer Care 12:263–273

    Article  CAS  Google Scholar 

  40. Ell K, Xie B, Wells A, Nedjat-Haiem F, Lee PJ, Vourlekis B (2008) Economic stress among low-income women with cancer: effects on quality of life. Cancer 112:616–625

    Article  PubMed  Google Scholar 

  41. Markman M, Luce R (2010) Impact of the cost of cancer treatment: an internet-based survey. J Oncol Pract 6:69–73

    Article  PubMed  PubMed Central  Google Scholar 

  42. Lee MK, Park S, Lee ES, Ro J, Kang HS, Shin KH, Lee KS, Chung KW, Kim SW, Yun YH (2010) Social support and depressive mood 1 year after diagnosis of breast cancer compared with the general female population: a prospective cohort study. Support Cancer Care 2011; 19:1379–92

  43. Ceilleachair AO, Costello L, Finn C, Timmons A, Fitzpatrick P, Kapur K, Staines A, Sharp L (2012) Inter-relationships between the economic and emotional consequences of colorectal cancer for patients and their families: a qualitative study. BMC Gastroenterol 12:62

    Article  PubMed  Google Scholar 

  44. Fenn KM, Evans SB, McCorkle R, DiGiovanna MP, Pusztai L, Sanft T, Hofstatter EW, Killelea BK, Knobf MT, Lannin DR, Abu-Khalaf M, Horowitz NR, Chagpar AB (2014) Impact of financial burden of cancer on survivors’ quality of life. J Oncol Pract 10:332–338

    Article  PubMed  Google Scholar 

  45. Adams J, White M, Moffatt S, Howel D, Mackintosh J (2006) A systematic review of the health, social and financial impacts of welfare rights advice delivered in healthcare settings. BMC Public Health 6:81

    Article  PubMed  PubMed Central  Google Scholar 

  46. O’Neill B, Prawitz AD, Sorhaindo B, Kim J, Garman T (2006) Changes in health, negative financial events, and financial distress/financial wellbeing for debt management program clients. Financ Couns Plann 17:46–62

    Google Scholar 

  47. Rajurkar SP, Presant CA, Bosserman LD, McNatt WJ (2011) A copay foundation assistance program for patients receiving intravenous cancer therapy. J Oncol Pract 7:100–102

    Article  PubMed  PubMed Central  Google Scholar 

  48. Moffatt S, Noble E, White M (2012) Addressing the financial consequences of cancer: qualitative evaluation of a welfare rights advice service. PLoS One 7, e42979

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  49. Pisu M, Martin MY, Shewchuk R, Meneses K (2014) Dealing with the financial burden of cancer: perspectives of older breast cancer survivors. Support Care Cancer 22:3045–3052

    Article  PubMed  PubMed Central  Google Scholar 

  50. Morreno-Serra R, Millett C, Smith PC (2011) Towards improved measurement of financial protection in health. PLoS Med 8:1–6

    Article  Google Scholar 

  51. Maunsell E, Brisson C, Dubois L, Lauzier S, Fraser A (1999) Work problems after breast cancer: an exploratory qualitative study. Psychooncology 8:467–473

    Article  PubMed  CAS  Google Scholar 

  52. Steiner JF, Cavender TA, Main DS, Bradley CJ (2004) Assessing the impact of cancer on work outcomes. What are the research needs? Cancer 101:1703–1711

    Article  PubMed  Google Scholar 

  53. de Boer AG, Taskila T, Tamminga SJ, Frings-Dresen MH, Feuerstein M, Verbeek JH (2011) Interventions to enhance return-to-work for cancer patients. Cochrane Database Syst Rev 2, CD007569

    PubMed  Google Scholar 

Download references

Acknowledgments

We thank the participants and the consultants and their teams who confirmed survivors’ eligibility. We are also grateful to the following: the Steering Committee (Harry Comber, Noeleen Donnelly, Joan Kelly, John McCormack, Niamh Ni Chonghaile, Eileen O’Donnell, Olwyn Ryan); Claire O’Callaghan for clerical support; NCR staff involved in collection and processing of cancer registrations and Professor Phyllis Butow for helpful discussions.

Conflict of interest

The study was funded by the Irish Cancer Society. Representatives of the funders sat on the Steering Committee and provided advice regarding the design of the overall study and data collection. The funders had no role in the analyses for this paper, the decision to publish, or preparation of the manuscript, nor did they have access to the study data. The authors had full control of all primary data and are willing to allow the journal to review the data if requested. In 2011–12 LS held an unrestricted project grant from Sanofi-aventis for research into treatment patterns and survival in breast and prostate cancer. AT has no conflicts of interest to declare. We appreciate the support of COST Action IS1211 (CANWON).

Author information

Authors and Affiliations

  1. National Cancer Registry, Building 6800, Kinsale Road, Cork, Ireland

    Linda Sharp & Aileen Timmons

  2. Institute of Health & Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, Tyne and Wear, NE2 4AX, England, UK

    Linda Sharp

Authors
  1. Linda Sharp
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Aileen Timmons
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Linda Sharp.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary Table 1

(DOCX 24 kb)

Supplementary Table 2

(DOCX 24 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sharp, L., Timmons, A. Pre-diagnosis employment status and financial circumstances predict cancer-related financial stress and strain among breast and prostate cancer survivors. Support Care Cancer 24, 699–709 (2016). https://doi.org/10.1007/s00520-015-2832-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00520-015-2832-4

Keywords

Search

Navigation