title: Economic survivorship stress is associated with poor health-related quality of life among distressed survivors of hematopoietic stem cell transplantation.
abstract: BACKGROUND
  Hematopoietic stem cell transplantation is a demanding cancer treatment associated with enduring physical and psychological complications. Survivors' well-being may be further compromised by exposure to chronic stressors common to this population, including difficulties arising from costly medical care, changes in employment status, and health insurance coverage. Thus, we hypothesized that financial, employment, and insurance stressors (collectively referred to as economic survivorship stressors) would be associated with poorer health-related quality of life (HRQOL) among hematopoietic stem cell transplantation survivors.
  
  
  METHODS
  Survivors (n = 181; M = 640 days post-transplant) completed the measures of study variables through mailed questionnaires and telephone interviews. Hierarchical regression analyses were conducted to test the hypothesized associations between economic survivorship stressors and HRQOL, and to examine whether social and situational factors interact with survivors' stress perceptions to predict HRQOL.
  
  
  RESULTS
  Greater financial and employment stress were associated with poorer functioning across multiple HRQOL domains, even after controlling for the effects of possible confounding sociodemographic and medical variables. Insurance stress was not associated with HRQOL. Some associations were moderated by situational factors including timing of the current financial crisis and portion of the transplant paid for by health insurance.
  
  
  CONCLUSIONS
  Hematopoietic stem cell transplantation survivors can face serious economic challenges during recovery. Results suggest the value of viewing these challenges as chronic stressors capable of reducing survivors' mental and physical well-being. Identifying resources and skills that help survivors cope with these demands is an important goal for clinicians and researchers.
authors.affiliation: Cancer Prevention Fellowship Program, Center for Cancer Training, National Cancer Institute, Rockville, MD 20892–7331, USA. hamiltonjg@mail.nih.gov
authors.forename: Jada G
authors.initials: JG
authors.lastname: Hamilton
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Wu
authors.forename: Jane E
authors.initials: JE
authors.lastname: Austin
authors.forename: Heiddis
authors.initials: H
authors.lastname: Valdimarsdottir
authors.forename: Katie
authors.initials: K
authors.lastname: Basmajian
authors.forename: Annamarie
authors.initials: A
authors.lastname: Vu
authors.forename: Scott D
authors.initials: SD
authors.lastname: Rowley
authors.forename: Luis
authors.initials: L
authors.lastname: Isola
authors.forename: William H
authors.initials: WH
authors.lastname: Redd
authors.forename: Christine
authors.initials: C
authors.lastname: Rini
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D004651:Employment; D005260:Female; D006304:Health Status; D018380:Hematopoietic Stem Cell Transplantation / Q000191:economics* / Q000523:psychology*; D006801:Humans; D007182:Income; D007344:Insurance Claim Reporting; D007349:Insurance, Health, Reimbursement / Q000191:economics; D007407:Interviews as Topic; D008016:Life Change Events; D008297:Male; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D011788:Quality of Life / Q000523:psychology*; D012044:Regression Analysis; D012959:Socioeconomic Factors; D013315:Stress, Psychological / Q000191:economics* / Q000523:psychology; D011795:Surveys and Questionnaires; D017741:Survivors / Q000523:psychology*; D055815:Young Adult