title: The personal financial burden of complications after colorectal cancer surgery.
abstract: BACKGROUND
  Patients with colorectal cancer (CRC) may suffer significant economic hardship during treatment. Complications are common after surgery for CRC and may exacerbate the financial burden of CRC even further.
  
  
  METHODS
  Within a population-based survey of patients with stage III CRC, the authors investigated the effects of disease and treatment on personal finances and computed a composite measure of financial burden. Correlations were examined between components of financial burden and patient-reported postoperative complications using chi-square analyses, and Mantel-Haenszel chi-square tend tests were used to evaluate correlations between composite financial burden scores and surgical complications, controlling for patient characteristics and other factors by using multivariable Poisson regression.
  
  
  RESULTS
  Among 937 respondents, 224 (24%) reported complications after surgery. Those with complications had significantly higher composite financial burden (P < .001 for trend): they were more likely to spend savings (40% vs 31%; P  = .01), borrow or take loans (18% vs 11%; P = .007), fail to make credit card payments (18% vs 11%; P = .005), reduce spending for food or clothes (38% vs 27%; P = .001), and decrease recreational activities (41% vs 33%; P = .03). They took significantly longer to return to work (P  = .009) and were more likely to experience significant worry about finances (61% vs 52%; P = .01).
  
  
  CONCLUSIONS
  Complications after surgery for CRC result in significant personal financial consequences as well as morbidity. Financial stress impairs quality of life and may prevent adherence to recommended treatments. Therefore, patients who suffer complications may require not just additional clinical care but also economic support and services.
authors.affiliation: Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, Michigan; Department of Surgery, University of Michigan, Ann Arbor, Michigan.
authors.forename: Scott E
authors.initials: SE
authors.lastname: Regenbogen
authors.forename: Christine M
authors.initials: CM
authors.lastname: Veenstra
authors.forename: Sarah T
authors.initials: ST
authors.lastname: Hawley
authors.forename: Mousumi
authors.initials: M
authors.lastname: Banerjee
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Ward
authors.forename: Ikuko
authors.initials: I
authors.lastname: Kato
authors.forename: Arden M
authors.initials: AM
authors.lastname: Morris
mesh_terms: D000368:Aged; D003082:Colectomy / Q000009:adverse effects*; D015179:Colorectal Neoplasms / Q000150:complications / Q000191:economics* / Q000601:surgery*; D017281:Cost of Illness; D005260:Female; D006801:Humans; D007182:Income; D008297:Male; D008875:Middle Aged; D016012:Poisson Distribution; D011183:Postoperative Complications / Q000191:economics*; D011788:Quality of Life; D062707:Return to Work; D018426:SEER Program; D012959:Socioeconomic Factors; D014481:United States
keywords: colectomy; colorectal cancer; complications; employment; finances; patients; quality of life; socioeconomic factors; survivorship