Financial worry in people with cancer: Relationship to employment and outcomes

Background: People with cancer experience financial hardship. Most previous research has focused on material financial burden rather than financial worry. This study investigated employment predictors of financial worry and examined outcomes potentially affected by financial worry.

Methods: Data from the 2018 National Health Interview Study was used and limited to people diagnosed with cancer and having complete data on relevant variables (n = 2049). Preliminary analyses indicated three dimensions of financial worry: healthcare; lifestyle; and basic needs. Outcomes included cost-related nonadherence, and presence of depressive symptoms and anxiety. Multivariable regressions examined the association of financial worry with cost-related nonadherence and mental health and employment characteristics (paid hourly; sick leave; employer size) with financial worry while controlling for demographics.

Results: Mean age was 68.10 years (range: 20-85), and most had skin (33.6%), prostate (12.5%) or breast (21.4%) cancer. Hourly pay predicted more financial worry about affording healthcare (p < 0.001), basic needs (p < 0.001) and lifestyle (p < 0.001). Having paid sick leave predicted less worry about basic needs (p = 0.003). Worry about affording healthcare predicted more cost-related nonadherence (p < 0.001) even when controlling for other variables associated with financial hardship. Worry about lifestyle (p = 0.193) and basic needs (p = 0.688) were not associated with cost-related nonadherence. Worry about lifestyle (p < 0.001) predicted depression. Worry about affording healthcare (p = 0.042) and lifestyle (p < 0.001) predicted anxiety.

Conclusions: Research is needed to determine the value of financial worry screening, particularly about affording healthcare, as well as material financial hardship. Financial worry should be included as an outcome in policy evaluations and interventions for financial hardship.