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PURPOSE: The impact of financial burden among patients with cancer has not yet been measured in a way that accounts for inter-relationships between quality of life, perceived quality of care, disease status, and sociodemographic characteristics. PATIENTS AND METHODS: In a national, prospective, observational, population- and health care systems-based cohort study, patients with colorectal or lung cancer were enrolled from 2003 to 2006 within 3 months of diagnosis. For this analysis, surviving patients who were either disease free or had advanced disease were resurveyed a median 7. 3 years from diagnosis. Structural equation modeling was used to investigate relationships between financial burden, quality of life, perceived quality of care, and sociodemographic characteristics. RESULTS: Among 1, 000 participants enrolled from five geographic regions, five integrated health care systems, or 15 Veterans Administration Hospitals, 89% (n = 889) were cancer free, and 11% (n = 111) had advanced cancer. Overall, 48% (n = 482) reported difficulties living on their household income, and 41% (n = 396) believed their health care to be "excellent. " High financial burden was associated with lower household income (adjusted odds ratio OR = 0. 61 per 20k per year, P <. 001) and younger age (adjusted OR = 0. 63 per 10 years; P <. 001). High financial burden was also associated with poorer quality of life (adjusted beta = -0. 06 per burden category; P <. 001). Better quality of life was associated with fewer perceptions of poorer quality of care (adjusted OR = 0. 85 per 0. 10 EuroQol units; P <. 001). CONCLUSION: Financial burden is prevalent among cancer survivors and is related to patients' health-related quality of life. Future studies should consider interventions to improve patient education and engagement with regard to financial burden.
Zafar et al. (Sun,) studied this question.