Financial distress and its associated burden in couples coping with an advanced cancer
Open accessPublished version of a preprint
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.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
El 62% de pacientes y el 64% de cuidadores presentaron angustia financiera, correlacionada significativamente con las parejas (p < 0,001), ansiedad (p = 0.01), depresión (p = 0.001), una peor calidad de vida física tanto para los pacientes (p = 0,03) como para los cuidadores (p = 0.001), y una calidad de vida mental más baja en los pacientes (p < 0,001).
“En este estudio se pudo observar un 62% de pacientes con angustia financiera y un 64% en los cuidadores, correlacionada significativamente a las parejas (p < 0,001), a la ansiedad (p = 0.01), depresión (p = 0.001), una peor CdV física tanto para los pacientes (p = 0,03) como para los cuidadores (p = 0.001), y una CdV mental más baja en los pacientes (p < 0,001).”
From Sobrecarga de trabajo en cuidadores de pacientes en cuidados paliativos oncológicos: Una revisión bibliográfica (2023) · cites this paper as Kroll et al., 2022
Split into 2 atoms — 1 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measured
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
The citation lists haven’t been fetched yet
References 47 · Cited by 26
Research works printed but not linked: 33
- Kim Y, Kashy DA, Wellisch DK, Spillers RL, Kaw CK, Smith TG. Quality of life of couples dealing with cancer: dyadic and individual adjustment among breast and prostate cancer survivors and their spousal caregivers. Ann Behav Med. 2008;35(2):230-238. doi:10.1007/s12160-008-9026-y. · DOI
- Fletcher BS, Miaskowski C, Given B, Schumacher K. The cancer family caregiving experience: an updated and expanded conceptual model. Eur J Oncol Nurs. 2012;16(4):387-398. doi:10.1016/j.ejon.2011.09.001. · DOI
- Clark MM, Rummans TA, Sloan JA, et al. Quality of life of caregivers of patients with advanced-stage cancer. Am J Hosp Palliat Care. 2006;23(3):185-191. doi:10.1177/1049909106289074. · DOI
- Jacobs JM, Shaffer KM, Nipp RD, et al. Distress is Interdependent in Patients and Caregivers with Newly Diagnosed Incurable Cancers. Ann Behav Med. 2017;51(4):519-531. doi:10.1007/s12160-017- 9875-3. · DOI
- Milbury K, Badr H, Fossella F, Pisters KM, Carmack CL. Longitudinal associations between caregiver burden and patient and spouse distress in couples coping with lung cancer. Support Care Cancer. 2013;21(9):2371-2379. doi:10.1007/s00520-013-1795-6. · DOI
- Meyler D, Stimpson JP, Peek MK. Health concordance within couples: a systematic review. Soc Sci Med. 2007;64(11):2297-2310. doi:10.1016/j.socscimed.2007.02.007 · DOI
- Streck BP, Wardell DW, LoBiondo-Wood G, Beauchamp JES. Interdependence of physical and psychological morbidity among patients with cancer and family caregivers: Review of the literature. Psychooncology. 2020;29(6):974-989. doi:10.1002/pon.5382 · DOI
- Mariotto AB, Enewold L, Zhao J, Zeruto CA, Yabroff KR. Medical Care Costs Associated with Cancer Survivorship in the United States. Cancer Epidemiol Biomarkers Prev June 10 2020 DOI: 10.1158/1055- 9965.EPI-19-1534. · DOI
- Zafar SY. Financial Toxicity of Cancer Care: It's Time to Intervene. J Natl Cancer Inst. 2015;108(5):djv370. Published 2015 Dec 11. doi:10.1093/jnci/djv370. · DOI
- Zullig LL, Peppercorn JM, Schrag D, Taylor DH, Jr., Lu Y, Samsa G, Abernethy AP, Zafar SY. Financial Distress, Use of Cost-Coping Strategies, and Adherence to Prescription Medication Among Patients With Cancer. Journal of oncology practice. 2013;9(6S):60s-3s. doi: 10.1200/JOP.2013.000971. PubMed PMID: 29431038; PMCID: 3825170. · DOI
- Smith GL, Lopez-Olivo MA, Advani PG, et al. Financial Burdens of Cancer Treatment: A Systematic Review of Risk Factors and Outcomes. Journal of the National Comprehensive Cancer Network: JNCCN 2019;17:1184-9
- Yabroff KR, Lund J, Kepka D, Mariotto A. Economic burden of cancer in the United States: estimates, projections, and future research. Cancer Epidemiol Biomarkers Prev. 2011;20(10):2006-2014. doi:10.1158/1055-9965.EPI-11-0650. · DOI
- Arastu A, Patel A, Mohile SG, et al. Assessment of Financial Toxicity Among Older Adults with Advanced Cancer. JAMA Netw Open. 2020;3(12):e2025810. doi:10.1001/jamanetworkopen.2020.25810. · DOI
- Shankaran V, Unger JM, Darke A, Suga JM, Wade JL, Kourlas P, Sreenivasa R Chandana SR, O'Rourke MA, Satti S, Liggett D, Hershman DL, and Ramsey SD. Cumulative incidence of nancial hardship in metastatic colorectal cancer patients: Primary endpoint results for SWOG S1417CD. Journal of Clinical Oncology 2020 38:15_suppl, 7010-7010.
- Ramsey SD, Bansal A, Fedorenko CR, et al. Financial Insolvency as a Risk Factor for Early Mortality Among Patients With Cancer. Journal of clinical oncology: o cial journal of the American Society of Clinical Oncology 2016;34:980-6.
- Van Houtven CH, Ramsey SD, Hornbrook MC, Atienza AA, van Ryn M. Economic burden for informal caregivers of lung and colorectal cancer patients. Oncologist. 2010;15(8):883-893. doi:10.1634/theoncologist.2010-0005. · DOI
- Li C, Zeliadt SB, Hall IJ, et al. Burden among partner caregivers of patients diagnosed with localized prostate cancer within 1 year after diagnosis: an economic perspective. Support Care Cancer. 2013;21(12):3461-3469. doi:10.1007/s00520-013-1931-3. · DOI
- Girgis A, Lambert S, Johnson C, Waller A, Currow D. Physical, psychosocial, relationship, and economic burden of caring for people with cancer: a review. J Oncol Pract. 2013;9(4):197-202. doi:10.1200/JOP.2012.000690. · DOI · Paper page
- Delgado-Guay M, Ferrer J, Rieber AG, et al. Financial Distress and Its Associations with Physical and Emotional Symptoms and Quality of Life Among Advanced Cancer Patients. Oncologist. 2015;20(9):1092-1098. doi:10.1634/theoncologist.2015-0026. · DOI
- Mercadante S, Aielli , Adile C. et al. Financial distress and its impact on symptom expression in advanced cancer patients. Support Care Cancer 29, 485-490 (2021). https://doi.org/10.1007/s00520- 020-05507-9. · DOI
- Falconier MK, Kuhn R. Dyadic Coping in Couples: A Conceptual Integration and a Review of the Empirical Literature. Front Psychol. 2019;10:571. Published 2019 Mar 26. doi:10.3389/fpsyg.2019.00571. · DOI
- Bruera E, Kuehn N, Miller MJ et al. The Edmonton Symptom Assessment System' (ESAS): a simple method for the assessment of palliative care patients. J Palliat Care 1991;7:6 PubMed: 1714502.
- Radloff LS. The CES-D scale: A new self-report depression scale for research in the general population. Applied Psychological Measurement 1977; 1:385-401.
- Hays RD, Bjorner JB, Revicki DA, Spritzer KL, Cella Development of physical and mental health summary scores from the patient-reported outcomes measurement information system (PROMIS) global items. Qual Life Res 2009;18:7:873-880 PubMed: 19543809.
- Arden-Close E, Moss-Morris R, Dennison L, Bayne L, Gidron Y. The Couples' Illness Communication Scale (CICS): development and validation of a measure assessing illness-related couple communication. Br J Health Psychol 2010;15:543-559.
- Kenny DA, Kashy DA, Cook WL: Dyadic data analysis. New York, Guilford Press, 2006.
- Barbaret C, Delgado-Guay MO, Sanchez S, et al. Inequalities in Financial Distress, Symptoms, and Quality of Life Among Patients with Advanced Cancer in France and the U.S. Oncologist. 2019;24(8):1121-1127. doi:10.1634/theoncologist.2018-0353. · DOI
- Lopez G, Milbury K, Chen M, Li Y, Bruera E, Cohen L. Couples' symptom burden in oncology care: perception of self and the other. Support Care Cancer. 2019;27(1):139-145. doi:10.1007/s00520-018- 4298-7. · DOI
- Langer SL, Brown JD, Syrjala KL. Intrapersonal and interpersonal consequences of protective buffering among cancer patients and caregivers. Cancer. 2009;115(18 Suppl):4311-4325. doi:10.1002/cncr.24586. · DOI
- Manne SL, Norton TR, Ostroff JS, Winkel G, Fox K, Grana G. Protective buffering and psychological distress among couples coping with breast cancer: The moderating role of relationship satisfaction. J Fam Psychol. 2007;21(3):380-388. doi:10.1037/0893-3200.21.3.380. · DOI
- Fenn KM, Evans SB, McCorkle R, et al. Impact of nancial burden of cancer on survivors' quality of life. J Oncol Pract. 2014;10(5):332-338 doi:10.1200/JOP.2013.001322. · DOI
- Tarnasky AM, Tran GN, Nicolla J, Friedman FAP, Wolf S, Troy JD et al. Mobile Application to Identify Cancer Treatment-Related Financial Assistance: Results of a Randomized Controlled Trial. Journal of Clinical Oncology Practice 2021; PMID: 33797952; DOI 10.1200/OP.20.00757. · DOI
- Nipp RD, Lee H, Gorton E, et al. Addressing the Financial Burden of Cancer Clinical Trial Participation: Longitudinal Effects of an Equity Intervention. Oncologist. 2019;24(8):1048-1055. doi:10.1634/theoncologist.2019-0146. Tables Table 1. Participant demographics and characteristics JLKrollCOIForm520.pdf KimCOIForm520.pdf KrollFDCouplesCoverLetter.pdf MilburyCOIForm520.pdf SmithCOIForm520.pdf WeathersCOIForm520.pdf · DOI
- Authors
- Kroll, J. L., Kim, S., Cho, D., Weathers, S.-P., Chen, A. B., Smith, G., Bruera, E., & Milbury, K.
- Affiliations
- The University of Texas MD Anderson Cancer Center (US)
- Corresponding author
- Kroll, Juliet L.
- ORCID
- Venue
- Supportive Care in Cancer
- Published
- 2022-02-03
- Volume
- 30
- Issue
- 5
- Pages
- 4485-4495
- ISSN
- 0941-4355 (ISSN-L)
- 1433-7339
- OpenAlex
- W4210318758
- Cited by
- 26
- References
- 47
- Citations by year
- 2026: 2 · 2025: 5 · 2024: 5 · 2023: 4 · 2022: 10
- FWCI
- 4.83
- Type
- journal article
- Language
- en
- Open access
- green
- doi.org
- Locations
- Supportive Care in Cancer (publishedVersion)
- Research Square (acceptedVersion, cc-by)
- PubMed (publishedVersion)
- Funders
- Cancer Prevention and Research Institute of Texas (RP170259)
- U.S. Department of Defense (W81XWH-19-1-0460)
- Topics
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Economic and Financial Impacts of Cancer
- Health Sciences › Medicine › Oncology › Cancer survivorship and care
- Social Sciences › Sociology and Political Science › Family Support in Illness
- Keywords
- financial distress, advanced cancer, spousal caregivers, couples, illness communication, quality of life, anxiety, depression, lung cancer, brain tumors, symptom perception, dyadic assessment, psychological distress, physical quality of life, caregiver burden, incurable disease, underreporting
- MeSH terms
- Adaptation, Psychological, Humans, Lung Neoplasms, Quality of Life, Caregivers, Spouses
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
