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J Cancer Surviv. 2018 Oct 24. doi: 10.1007/s11764-018-0723-7. [Epub ahead of print]

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

Author information

1
Centre for Health Economics Research and Evaluation, University of Technology Sydney, PO Box 123, Broadway, NSW, 2007, Australia. Alison.pearce@chere.uts.edu.au.
2
Flinders Centre for Innovation in Cancer, Flinders University, Adelaide, Australia.
3
Health Economics Unit, Flinders University, Adelaide, Australia.
4
Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands.
5
Department of Research, The Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands.
6
Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
7
Department of General Practice, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands.
8
Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.

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.

KEYWORDS:

Cancer; Cost; Employment; Financial toxicity; Survivorship; Work

PMID:
30357537
DOI:
10.1007/s11764-018-0723-7

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