Financial Toxicity From Cancer Can Affect Caregivers’ Health

The stress and financial impact of cancer not only affects the patient, but their loved ones as well, which can lead to decreases in health-related quality of life for partners of cancer survivors, according to recent research that was published in JAMA.

The researchers surveyed patients with colorectal cancer and their partners to get a better grasp of how the disease can affect health outcomes such as sleep and pain. Two of the researchers, Lauren V. Ghazal, a research fellow at the University of Michigan School of Nursing, and Dr. Christine Veenstra, an associate professor of medical oncology and internal medicine at University of Michigan Health, recently spoke with CURE® about their findings.

“We studied the health-related quality of life in partners because we know that their lives are also drastically impacted by their partner's cancer diagnosis, and this phenomenon has been long under-studied,” Ghazal and Veenstra said in an interview with CURE®.

Of note, according to the Centers for Disease Control and Prevention, colorectal cancer has the second highest treatment cost of any cancer, with the first year of treatment typically being the most expensive for patients and their families.

Can you give a brief summary/take-home points from your study?

We surveyed both patients who had been treated between one and five years earlier for stage 3 colorectal cancer and their spouses, domestic partners or significant others who lived in the same household. (A total of) 307 patient-partner pairs responded.

More than two-thirds of patient-partner groups reported adverse financial outcomes, while 29% reported that they are in debt due to colorectal cancer and/or its treatments.

Almost two-thirds of partners reported financial burden due to the cancer, including cutting down on expenses, activities, food or clothes, or using savings. About a third of partners had high financial worry, which increased the more they lost income or missed work. And 29% of partners reported debt related to the cancer diagnosis and treatment.

Younger partners were significantly more likely to report financial burden and debt, which is striking because colorectal cancer has increased in younger adults in recent years. Financial toxicity among partners was associated with worse quality of life in multiple areas, including pain, fatigue, sleep and social functioning.

How is it that financial concerns can end up affecting physical health?

For partners of colorectal cancer survivors, financial concerns can end up affecting specific domains of quality of life, like pain, sleep, anxiety and depressive symptoms, in multiple ways. In their own words, partners in our study described medical expenses and bills that led to debt, sometimes causing them to exhaust savings or retirement funds, sell personal items, and ask family and friends for money.

Some partners noted changes in personal spending habits — spending more money to cope with the emotional stress of cancer. Worrying about finances or feeling like they’ve lost the support of friends and family because of financial problems can affect partners’ quality of life. For example, the emotional toll of worrying about financial toxicity and the inability to afford their own medical care could both affect partners’ physical pain. Having debt and dealing with “never-ending” calls from bill collectors could affect partners’ sleep and lead to disturbances in sleep or loss of sleep.

What is your advice for cancer caregivers who are experiencing negative impacts on health-related quality of life due to financial stress from their loved one’s cancer diagnosis?

Telling your partner’s cancer providers about financial problems related to the cancer or its treatment is important. They may not know about the problems or may not ask about them unless you bring them up. Getting connected to financial navigation services, or a social worker, early and often is a good first step to intervening on financial toxicity. Talking to your own doctor or health care provider about the negative impacts on your health-related quality of life can also be helpful.

What further research/work is needed in this field?

Researchers and oncology care providers need to better engage partners and caregivers in the support of cancer survivors. More research is needed to identify solutions to financial toxicity at the level of employers and at the level of health policy. Additional research is also needed on the experiences of younger partners/caregivers, who we saw were more impacted by financial toxicity.

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