title: Economic impact of advanced pediatric cancer on families.
abstract: BACKGROUND
  Despite emerging evidence of substantial financial distress in families of children with complex illness, little is known about economic hardship in families of children with advanced cancer.
  
  
  OBJECTIVE
  To describe perceived financial hardship, work disruptions, income losses, and associated economic impact in families of children with advanced cancer stratified by federal poverty level (FPL).
  
  
  METHODS
  Cross-sectional survey of 86 parents of children with progressive, recurrent, or nonresponsive cancer at three children's hospitals. Seventy-one families with complete income data (82%) are included in this analysis.
  
  
  RESULTS
  Parental work disruptions were prevalent across all income levels, with 67 (94%) families reporting some disruption. At least one parent quit a job because of the child's illness in 29 (42%) families. Nineteen (27%) families described their child's illness as a great economic hardship. Income losses because of work disruptions were substantial for all families; families at or below 200% FPL, however, were disproportionately affected. Six (50%) of the poorest families lost more than 40% of their annual income as compared with two (5%) of the wealthiest families (P = 0.006). As a result of income losses, nine (15%) previously nonpoor families fell from above to below 200% FPL.
  
  
  CONCLUSIONS
  The economic impact of pediatric advanced cancer on families is significant at all income levels, although poorer families suffer disproportionate losses. Development of ameliorative intervention strategies is warranted.
authors.affiliation: Department of Medicine, Boston Children's Hospital, Boston, Massachusetts, USA; Department of Pediatric Hematology/Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Kira
authors.initials: K
authors.lastname: Bona
authors.affiliation: Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina.
authors.forename: Veronica
authors.initials: V
authors.lastname: Dussel
authors.affiliation: Institute of Calculus, School of Sciences, University of Buenos Aires, Buenos Aires, Argentina.
authors.forename: Liliana
authors.initials: L
authors.lastname: Orellana
authors.affiliation: The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
authors.forename: Tammy
authors.initials: T
authors.lastname: Kang
authors.affiliation: Division of Pediatric Hematology/Oncology, Seattle Children's Hospital, Seattle, Washington, DC, USA; Fred Hutchinson Cancer Research Center, Seattle, Washington, DC, USA; University of Washington, Seattle, Washington, DC, USA.
authors.forename: Russ
authors.initials: R
authors.lastname: Geyer
authors.affiliation: The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
authors.forename: Chris
authors.initials: C
authors.lastname: Feudtner
authors.affiliation: Department of Medicine, Boston Children's Hospital, Boston, Massachusetts, USA; Department of Pediatric Hematology/Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA. Electronic address: Joanne_wolfe@dfci.harvard.edu.
authors.forename: Joanne
authors.initials: J
authors.lastname: Wolfe
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D002648:Child; D003430:Cross-Sectional Studies; D005190:Family; D005260:Female; D006801:Humans; D007182:Income / Q000706:statistics & numerical data; D008297:Male; D009369:Neoplasms / Q000191:economics*; D010290:Parents; D011203:Poverty / Q000191:economics; D012959:Socioeconomic Factors; D014481:United States
keywords: Pediatric; disparities; financial; oncology; palliative care; poverty