Financial Strain and Physical and Emotional Quality of Life in Breast Cancer

Context. Few studies have examined the association between financial strain and quality of life outcomes in breast cancer. Objectives. To examine the association between financial strain and key elements of physical and emotional quality of life among women with breast cancer. Methods. Across three geographically diverse samples (census regions: Northeast = 13.2%, Midwest = 26.8%, South = 35.5%, West = 17.4%; international = 7.1%), 309 women with a history of breast cancer completed online surveys including measures of financial strain, depression, anxiety, symptom burden, and perceived health. The third sample (N = 134) also reported financial toxicity that specifically documents financial strain because of medical care costs. Primary analyses assessed the association between financial strain and measures of emotional and physical quality of life. Sensitivity analyses examined associations using the measure of financial toxicity. All analyses were controlled for key covariates. Results. Results showed that 37.5% of women experienced financial strain (Samples 1-3), varying from 12.1% among older, married, and college-educated women to 81.0% among women who were younger, unmarried, and lacked a college education. In addition, 26.1% reported treatment-specific financial toxicity (Sample 3). Financial strain was associated with more severe symptoms of depression (P < 0.001) and anxiety (P < 0.001) and worse physical symptom burden (P < 0.001) and perceived health (P < 0.001). Observed effects were sustained in sensitivity analyses using the financial toxicity measure. Conclusions. The present investigation illustrates the importance of financial strain in breast cancer. Healthcare systems are encouraged to expand interdisciplinary palliative and supportive care services that have the expertise necessary to help financially strained patients navigate the cancer care continuum. (C) 2019 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.