title: Associations between cancer-related financial stress and strain and psychological well-being among individuals living with cancer.
abstract: BACKGROUND
  Cancer places a financial and economic burden on individuals, but relatively little is known about the consequences. We investigated associations between cancer-related financial stress and strain and psychological well-being.
  
  
  METHODS
  Individuals >6 months post-diagnosis with breast, prostate and lung cancer, identified from the National Cancer Registry Ireland, completed a postal questionnaire. Financial stress was assessed by the impact of the cancer diagnosis on household ability to make ends meet, financial strain by feelings about household financial situation since the cancer diagnosis and psychological well-being (depression, anxiety and distress) by the Depression Anxiety Stress Scales-21. Logistic regression was used to identify associations between financial stress and strain and depression, anxiety and distress of (a) any severity and (b) severe or worse.
  
  
  RESULTS
  The response rate was 54%. Of 654 respondents, 49% reported increased financial stress and 32% increased financial strain due to cancer. Depression, anxiety and distress were present in: 36%, 29% and 29%, respectively (any severity); and 14%, 13% and 13%, respectively (severe or worse). In adjusted analyses, depression risk was raised threefold in those reporting increased cancer-related financial stress (odds ratio (OR) = 2.79, 95%CI 1.87-4.17) and increased cancer-related financial strain (OR = 3.56, 95%CI 2.23-5.67). For severe or worse depression, the risk estimates were more pronounced (increased stress: OR = 4.36, 95%CI 2.35-8.10; increased strain: OR = 8.21, 95%CI 3.79-17.77). Similar associations were found for anxiety and distress.
  
  
  CONCLUSIONS
  Cancer-related financial stress and strain were consistently associated with increased risk of adverse psychological outcomes. If confirmed, these findings provide further rationale for initiatives to alleviate the financial burden of cancer.
authors.affiliation: National Cancer Registry, Cork, Ireland. linda.sharp@ncri.ie
authors.forename: Linda
authors.initials: L
authors.lastname: Sharp
authors.forename: Anne-Elie
authors.initials: AE
authors.lastname: Carsin
authors.forename: Aileen
authors.initials: A
authors.lastname: Timmons
mesh_terms: D000328:Adult; D000368:Aged; D001007:Anxiety / Q000191:economics / Q000453:epidemiology / Q000523:psychology*; D003863:Depression / Q000191:economics / Q000453:epidemiology / Q000523:psychology*; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D007494:Ireland / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D009369:Neoplasms / Q000191:economics* / Q000523:psychology*; D011159:Population Surveillance; D015995:Prevalence; D011569:Psychiatric Status Rating Scales; D011788:Quality of Life / Q000523:psychology*; D012959:Socioeconomic Factors; D013315:Stress, Psychological / Q000191:economics*; D011795:Surveys and Questionnaires; D017741:Survivors / Q000523:psychology