title: Perceived cancer-related financial difficulty: implications for patient satisfaction with quality of life in advanced cancer.
abstract: OBJECTIVE
  Cancer and its treatment often lead to financial difficulty in patients with advanced cancer. The goal of this study was to investigate the relationship between perceived cancer-related financial difficulty and patient satisfaction with quality of life (QoL) in advanced cancer.
  
  
  METHODS
  A case series of 954 cancer patients treated at Cancer Treatment Centers of America, a private tertiary care oncology facility in the USA, was investigated. Perceived financial difficulty was measured using the QLQ-C30 financial difficulty subscale. Patient satisfaction with QoL was measured using the Ferrans and Powers Quality of Life Index (QLI). The relationship between perceived financial difficulty and QLI was evaluated using multivariate analysis of variance and multiple regression analysis.
  
  
  RESULTS
  Of 954 patients, 579 were women and 375 were men, with the median age at presentation of 56 years (range 20-90 years). Sixty-six percent did not respond to prior treatment. Most common cancers were breast (26%), colorectal (19%), and lung (16%). Two hundred ninety-six (31%) patients perceived their financial condition as poor. Every 10-year increase in current age was significantly associated with a decline in all QLI subscales except for family subscale. Newly diagnosed patients had significantly better QLI scores for all subscales as compared to those who did not respond to definitive treatment elsewhere before coming to our hospital. After controlling for the effects of age and treatment history, every 10-unit increase in perceived financial difficulty score was statistically significantly associated with 0.52, 0.36, 0.32, 0.24, and 0.40 unit decline in QLI health/physical, social/economic, psychological/spiritual, family, and overall function score, respectively.
  
  
  CONCLUSIONS
  We found that perceived financial difficulty is strongly correlated with patient satisfaction with QoL in advanced cancer. These findings indicate a need for the providers of cancer care to be aware that nonclinical factors such as perceived financial difficulty can have an important bearing on QoL of cancer patients.
authors.affiliation: Office of Research, Cancer Treatment Centers of America at Midwestern Regional Medical Center, 2610 Sheridan Road, Zion, IL 60099, USA. digant.gupta@ctca-hope.com
authors.forename: Digant
authors.initials: D
authors.lastname: Gupta
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Lis
authors.forename: James F
authors.initials: JF
authors.lastname: Grutsch
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017281:Cost of Illness; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000191:economics* / Q000628:therapy; D017060:Patient Satisfaction; D011788:Quality of Life; D013812:Therapeutics / Q000191:economics; D014481:United States