Abstract
Purpose
Coping behaviors may play a mediating role in producing the negative health outcomes observed in financially burdened cancer patients and survivors.
Methods
Exploratory factor and latent class analysis of survey data.
Results
A total of 510 people completed the survey, ages ranged from 25 to over 75 [over half greater than 55 years old (57.8%)]. Most respondents identified as female (64.7%), white (70.8%), or African American (18.6%). A four-factor model of financial coping was revealed: care-altering, lifestyle-altering, self-advocacy, and financial help-seeking. Respondents grouped into three financial coping classes: low burden/low coping (n = 212), high self-advocacy (n = 143), and high burden/high coping (n = 155). African American respondents were at far greater odds than white respondents of being in the high burden/high coping class (OR = 5.82, 95% CI 3.01–6.64) or the self-advocacy class (OR = 1.99, 95% CI 1.19–2.80) than the low burden/low coping class. Compared to respondents aged 65 years and older, those 35–44 were more likely in the high burden/high coping class (OR = 12.27, 95% CI 7.03–19.87) and the high self-advocacy class (OR = 7.08, 95% CI 5.89–8.28) than the low burden/low coping class.
Conclusion
One-third of respondents were in the high burden/high coping class. Age and race/ethnicity were significantly associated with class membership. Some coping strategies may compromise health and well-being. Program and policy interventions that reduce the odds that patients will use strategies that undermine treatment outcomes and increase patient use of protective strategies are needed.
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Data Availability
The data that support the findings of this study are available from CancerCare. Restrictions apply to the availability of these data, which were used under license for this study. Data are available from the authors with the permission of Ellen Miller-Sonet (esonet@cancercare.org).
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Code availability
R code used for these analyses is available upon request from the authors.
Funding
Postdoctoral Fellowship in Psycho-Oncology [MSKCC Strategy & Innovation]; Cancer Center Support Grant (Population Science Research Program) [P30 CA008748-51, NCI]; American Cancer Society Doctoral Training Grant [129554-DSW-16-071-01-SW, ACS].
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Dr. Doherty conceptualized and wrote 90% of the manuscript, Dr. Garder assisted in conceptualizing and editing, and Ms. Finik designed, conducted, and wrote up the statistical approach, results, and tables.
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Ethical approval was provided by the Human Research Protection Program (HRPP) of Hunter College, City University of New York determined that this study, a secondary analysis of de-identified survey data, did not meet the requirements for human subjects research and was therefore exempt from IRB review (IRB File #2017-0067).
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Under the informed consent terms of the original study, reviewed and approved by the Human Research Protection Program (HRPP) of Hunter College, City University of New York, respondents provided written consent to participate.
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Under the informed consent terms of the original study, reviewed and approved by the Human Research Protection Program (HRPP) of Hunter College, City University of New York, participants permitted the researchers to use their responses for the purposes of ongoing research.
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Doherty, M., Gardner, D. & Finik, J. The financial coping strategies of US cancer patients and survivors. Support Care Cancer 29, 5753–5762 (2021). https://doi.org/10.1007/s00520-021-06113-z
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DOI: https://doi.org/10.1007/s00520-021-06113-z