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Financial distress and its associated burden in couples coping with an advanced cancer

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Abstract

Purpose

In efforts to understand financial distress (FD) associated with advanced cancer care from the perspective of both patients with incurable disease and their spousal caregivers, we assessed FD in both members of the couple, identified symptom and quality of life (QOL) correlates, and examined the potential role of illness communication.

Methods

Patients undergoing treatment for stage III/IV lung cancer or a grade III/IV primary brain tumor and their spousal caregivers (n = 76 dyads) completed measures of somatic and affective symptoms including FD, physical and mental QOL, and ease of engaging in illness communication. Patients and caregivers additionally rated their perception of each other’s symptoms, including FD.

Results

FD was endorsed by both patients (any FD 62.7%; high FD 24%) and spousal caregivers (any FD 64.7%; high FD 32.3%). Self-reported FD was significantly correlated (partial r = .52, p < .001) within couples. FD was associated with greater symptoms of anxiety (r = .29, p = .01; r = .31, p = .01), depression (r = 29, p = 01; r = .39, p = .001), and poorer physical QOL(r =  − .25, p = .03; r =  − .25, p = .001) for patients and caregivers, respectively. For patients, FD was additionally associated with poorer mental QOL(r =  − .44, p < .001). Caregivers accurately perceived patient FD, yet patients tended to underreport their caregiver’s FD by almost an entire point (t = 2.8, p = .007). A 3-way interaction (FD X role X illness communication) revealed (b = .40, p = .041) that illness communication moderated the association between FD and physical QOL for spouses so that spouses who reported less ease of illness communication demonstrated a stronger association between financial distress and physical QOL (b =  − 2.08, p < .001) than those reporting greater ease of engaging in illness communication (b = .49, p = .508).

Conclusion

In the advanced cancer setting, FD is prevalent in both patients and their spousal caregivers and associated with psychological distress and poor physical QOL. Results suggest that optimal FD assessment should include patients and spouses, and spouse’s ease of engaging with illness communication may be a potential target for future intervention studies.

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Availability of data and material

Data will be made available upon reasonable request by contacting the primary author.

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Funding

A portion of Dr. Kroll’s work on this manuscript was supported by funding from the Cancer Prevention and Research Institute of Texas (RP170259). A portion of Dr. Cho’s work on this manuscript was supported by funding from the Department of Defense (W81XWH-19–1-0460).

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Authors and Affiliations

  1. Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, 1155 Pressler, Houston, TX, 77005, USA

    Juliet L. Kroll, Seokhun Kim & Kathrin Milbury

  2. Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Dalnim Cho & Grace Smith

  3. Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Shiao-Pei Weathers

  4. Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Aileen B. Chen & Grace Smith

  5. Department of Palliative, Rehabilitation & Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Eduardo Bruera

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  1. Juliet L. Kroll
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  2. Seokhun Kim
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Contributions

JLK, KM, EB, and GS conceptualized the study. JK, SK, and DC analyzed the data. SW and ABC were involved with data collection. All authors contributed to the writing of the manuscript.

Corresponding author

Correspondence to Juliet L. Kroll.

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This study was approved by the MD Anderson Cancer Center Institutional Review Board.

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All participants provided written informed consent prior to participation in this study.

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All authors contributed to this work and reviewed the final version.

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The authors declare no competing interests.

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Kroll, J.L., Kim, S., Cho, D. et al. Financial distress and its associated burden in couples coping with an advanced cancer. Support Care Cancer 30, 4485–4495 (2022). https://doi.org/10.1007/s00520-021-06758-w

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