Financial toxicity is more than costs of care: the relationship between employment and financial toxicity in long-term cancer survivors

Abstract

Purpose

The aim of this study was to examine the relationship between employment and financial toxicity by examining the prevalence of, and factors associated with, financial toxicity among cancer survivors.

Methods

We conducted a secondary analysis of a sub-sample from the Dutch Patient Reported Outcomes Following Initial Treatment and Long-term Evaluation of Survivorship (PROFILES) registry. Descriptive statistics, bivariate analysis and logistic regression were used.

Results

A total of 2931 participants with diverse cancer types were included in the analysis with a mean age of 55 years (range 18 to 65). Nearly half (49%) of participants were employed at the time of the survey, and 22% reported financial toxicity. Those who were not employed were at greater risk of financial toxicity (27% vs 16%, p < 0.001), and this did not vary according to time since diagnosis. The odds of reporting financial toxicity were greater for participants who were male, younger, unmarried, with low education, low socioeconomic status, or without paid employment. Those with basal cell carcinoma had lower risk of financial toxicity, while those with haematological or colorectal cancer had highest risk of financial toxicity.

Conclusions

This research confirms that unemployment is significantly associated with financial toxicity and that those with limited financial resources are most at risk.

Implications for cancer survivors

Increased awareness of financial toxicity and its associated factors among clinicians may result in improved screening and appropriate referrals for support services. The implementation of effective multidisciplinary return to work interventions, as part of standard cancer survivorship care, may reduce financial toxicity among cancer survivors.

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References

  1. 1.

    de Souza JA, Yap BJ, Wroblewski K, Blinder V, Araújo FS, Hlubocky FJ, et al. Measuring financial toxicity as a clinically relevant patient-reported outcome: the validation of the comprehensive score for financial toxicity (COST). Cancer. 2017;123:476–84.

    Article  PubMed  Google Scholar 

  2. 2.

    Gordon LG, Merollini KMD, Lowe A, Chan RJ. A systematic review of financial toxicity among Cancer survivors: we Can’t pay the co-pay. Patient - Patient-Centered Outcomes Res. 2017;10:295–309.

    Article  Google Scholar 

  3. 3.

    Currow D, Aranda S. Financial toxicity in clinical care today: a “menu without prices”1. Med J Aust. 2016;204:397.

    Article  PubMed  Google Scholar 

  4. 4.

    Timmons A, Gooberman-Hill R, Sharp L. 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. 2013;21:107–17.

    Article  PubMed  Google Scholar 

  5. 5.

    Longo CJ, Fitch M, Deber RB, Williams AP. Financial and family burden associated with cancer treatment in Ontario. Canada Support Care Cancer. 2006;14:1077–85.

    Article  PubMed  Google Scholar 

  6. 6.

    Spelten ER, Sprangers MAG, Verbeek JHAM. Factors reported to influence the return to work of cancer survivors: a literature review. Psychooncology. 2002;11:124–31.

    Article  PubMed  Google Scholar 

  7. 7.

    Mehnert A. Employment and work-related issues in cancer survivors. Crit Rev Oncol Hematol. 2011;77:109–30.

    Article  PubMed  Google Scholar 

  8. 8.

    Guy GP, Ekwueme DU, Yabroff KR, Dowling EC, Li C, Rodriguez JL, et al. Economic burden of cancer survivorship among adults in the United States. J Clin Oncol. 2013;31:3749–57.

    Article  PubMed  PubMed Central  Google Scholar 

  9. 9.

    Taskila T, Lindbohm ML. Factors affecting cancer survivors’ employment and work ability. Acta Oncol Stockh Swed. 2007;46:446–51.

    Article  CAS  Google Scholar 

  10. 10.

    Kale HP, Carroll NV. Self-reported financial burden of cancer care and its effect on physical and mental health-related quality of life among US cancer survivors. Cancer. 2016;122:283–9.

    Article  PubMed  Google Scholar 

  11. 11.

    Fenn KM, Evans SB, McCorkle R, DiGiovanna MP, Pusztai L, Sanft T, et al. Impact of financial burden of cancer on survivors’ quality of life. J Oncol Pract. 2014;10:332–8.

    Article  PubMed  Google Scholar 

  12. 12.

    Zafar SY, Peppercorn JM, Schrag D, Taylor DH, Goetzinger AM, Zhong X, et al. The financial toxicity of cancer treatment: a pilot study assessing out-of-pocket expenses and the insured cancer patient’s experience. Oncologist. 2013;18:381–90.

    Article  PubMed  PubMed Central  Google Scholar 

  13. 13.

    Altice CK, Banegas MP, Tucker-Seeley RD, Yabroff KR. Financial hardships experienced by cancer survivors: a systematic review. JNCI J Natl Cancer Inst [Internet]. 2017 [cited 2017 Nov 23];109. Available from: https://academic.oup.com/jnci/article/109/2/djw205/2905657

  14. 14.

    Zafar SY, Abernethy AP. Financial toxicity, part I: a new name for a growing problem. Oncol Williston Park N. 2013;27:80–149.

    Google Scholar 

  15. 15.

    van de Poll-Franse LV, Horevoorts N, van Eenbergen M, Denollet J, Roukema JA, Aaronson NK, et al. The patient reported outcomes following initial treatment and long term evaluation of survivorship registry: scope, rationale and design of an infrastructure for the study of physical and psychosocial outcomes in cancer survivorship cohorts. Eur J Cancer. 2011;47:2188–94.

    Article  PubMed  Google Scholar 

  16. 16.

    Aaronson NK, Ahmedzai S, Bergman B, Bullinger M, Cull A, Duez NJ, et al. The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst. 1993;85:365–76.

    Article  CAS  Google Scholar 

  17. 17.

    Field, A. Discovering statistics with SPSS. 3rd ed. London: Sage Publications Ltd;

  18. 18.

    Huntington SF, Weiss BM, Vogl DT, Cohen AD, Garfall AL, Mangan PA, et al. Financial toxicity in insured patients with multiple myeloma: a cross-sectional pilot study. Lancet Haematol. 2015;2:e408–16.

    Article  PubMed  Google Scholar 

  19. 19.

    Schoen C, Osborn R, Squires D, Doty MM. Access, affordability, and insurance complexity are often worse in the United States compared to ten other countries. Health Aff Proj Hope. 2013;32:2205–15.

    Article  Google Scholar 

  20. 20.

    Hounshell J, Tomori C, Newlin R, Knox K, Rundhaugen L, Tallman M, et al. Changes in finances, insurance, employment, and lifestyle among persons diagnosed with hairy cell leukemia. Oncologist. 2001;6:435–40.

    Article  CAS  PubMed  Google Scholar 

  21. 21.

    Shankaran V, Jolly S, Blough D, Ramsey SD. Risk factors for financial hardship in patients receiving adjuvant chemotherapy for colon cancer: a population-based exploratory analysis. J Clin Oncol Off J Am Soc Clin Oncol. 2012;30:1608–14.

    Article  Google Scholar 

  22. 22.

    Amir Z, Brocky J. Cancer survivorship and employment: epidemiology. Occup Med Oxf Engl. 2009;59:373–7.

    Article  CAS  Google Scholar 

  23. 23.

    Gordon LG, Beesley VL, Lynch BM, Mihala G, McGrath C, Graves N, et al. The return to work experiences of middle-aged Australian workers diagnosed with colorectal cancer: a matched cohort study. BMC Public Health. 2014;14:963.

    Article  PubMed  PubMed Central  Google Scholar 

  24. 24.

    Gordon LG, Beesley VL, Mihala G, Koczwara B, Lynch BM. Reduced employment and financial hardship among middle-aged individuals with colorectal cancer. Eur J Cancer Care (Engl). 2017;26.

  25. 25.

    Zajacova A, Dowd JB, Schoeni RF, Wallace RB. Employment and income losses among cancer survivors: estimates from a national longitudinal survey of American families. Cancer. 2015;121:4425–32.

    Article  PubMed  PubMed Central  Google Scholar 

  26. 26.

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

  27. 27.

    OECD. Unemployment rate (indictor). https://doi.org/10.1787/997c8750-en. 2018 (Accessed on 09 October 2018).

  28. 28.

    Tamminga SJ, de Boer AGEM, Verbeek JHA, Frings-Dresen MHW. Return-to-work interventions integrated into cancer care: a systematic review. Occup Environ Med. 2010;67:639–48.

    Article  CAS  PubMed  Google Scholar 

  29. 29.

    Camburn T. Managing chemotherapy capacity by sharing best practice [Internet]. 2008 [cited 2017 Dec 8]. Available from: http://journals.rcni.com/doi/full/10.7748/cnp.7.5.29.s20

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Acknowledgements

This paper draws on data of the PROFILES registry.

Funding

Alison Pearce is supported by a University of Technology Sydney Chancellor’s Postdoctoral Research Fellowship. Saskia Duijts was supported by funding from the Dutch Cancer Society KWF fellowship (VUP 2013-5866). Bogda Koczwara is supported by the National Breast Cancer Foundation Fellowship.

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Correspondence to Alison Pearce.

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The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.

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Pearce, A., Tomalin, B., Kaambwa, B. et al. Financial toxicity is more than costs of care: the relationship between employment and financial toxicity in long-term cancer survivors. J Cancer Surviv 13, 10–20 (2019). https://doi.org/10.1007/s11764-018-0723-7

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Keywords

  • Cancer
  • Survivorship
  • Financial toxicity
  • Cost
  • Employment
  • Work