title: Population-based assessment of cancer survivors' financial burden and quality of life: a prospective cohort study.
abstract: OBJECTIVE
  The impact of financial burden among patients with cancer has not yet been measured in a way that accounts for inter-relationships between quality of life, perceived quality of care, disease status, and sociodemographic characteristics.
  
  
  METHODS
  In a national, prospective, observational, population- and health care systems-based cohort study, patients with colorectal or lung cancer were enrolled from 2003 to 2006 within 3 months of diagnosis. For this analysis, surviving patients who were either disease free or had advanced disease were resurveyed a median 7.3 years from diagnosis. Structural equation modeling was used to investigate relationships between financial burden, quality of life, perceived quality of care, and sociodemographic characteristics.
  
  
  RESULTS
  Among 1,000 participants enrolled from five geographic regions, five integrated health care systems, or 15 Veterans Administration Hospitals, 89% (n = 889) were cancer free, and 11% (n = 111) had advanced cancer. Overall, 48% (n = 482) reported difficulties living on their household income, and 41% (n = 396) believed their health care to be "excellent." High financial burden was associated with lower household income (adjusted odds ratio [OR] = 0.61 per $20k per year, P < .001) and younger age (adjusted OR = 0.63 per 10 years; P < .001). High financial burden was also associated with poorer quality of life (adjusted beta = -0.06 per burden category; P < .001). Better quality of life was associated with fewer perceptions of poorer quality of care (adjusted OR = 0.85 per 0.10 EuroQol units; P < .001).
  
  
  CONCLUSIONS
  Financial burden is prevalent among cancer survivors and is related to patients' health-related quality of life. Future studies should consider interventions to improve patient education and engagement with regard to financial burden.
authors.affiliation: Duke Cancer Institute; Center for Learning Health Care, Duke Clinical Research Institute; Duke University Medical Center; Cooperative Studies Program Epidemiology Center-Durham, Durham Veterans Affairs Medical Center Durham, Durham, NC; Medical University of South Carolina, Charleston, SC; Harvard Medical School; Dana-Farber Cancer Institute; and Brigham and Women's Hospital, Boston, MA yousuf.zafar@duke.edu.
authors.forename: S Yousuf
authors.initials: SY
authors.lastname: Zafar
authors.affiliation: Duke Cancer Institute; Center for Learning Health Care, Duke Clinical Research Institute; Duke University Medical Center; Cooperative Studies Program Epidemiology Center-Durham, Durham Veterans Affairs Medical Center Durham, Durham, NC; Medical University of South Carolina, Charleston, SC; Harvard Medical School; Dana-Farber Cancer Institute; and Brigham and Women's Hospital, Boston, MA.
authors.forename: Rebecca B
authors.initials: RB
authors.lastname: McNeil
authors.affiliation: Duke Cancer Institute; Center for Learning Health Care, Duke Clinical Research Institute; Duke University Medical Center; Cooperative Studies Program Epidemiology Center-Durham, Durham Veterans Affairs Medical Center Durham, Durham, NC; Medical University of South Carolina, Charleston, SC; Harvard Medical School; Dana-Farber Cancer Institute; and Brigham and Women's Hospital, Boston, MA.
authors.forename: Catherine M
authors.initials: CM
authors.lastname: Thomas
authors.affiliation: Duke Cancer Institute; Center for Learning Health Care, Duke Clinical Research Institute; Duke University Medical Center; Cooperative Studies Program Epidemiology Center-Durham, Durham Veterans Affairs Medical Center Durham, Durham, NC; Medical University of South Carolina, Charleston, SC; Harvard Medical School; Dana-Farber Cancer Institute; and Brigham and Women's Hospital, Boston, MA.
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Lathan
authors.affiliation: Duke Cancer Institute; Center for Learning Health Care, Duke Clinical Research Institute; Duke University Medical Center; Cooperative Studies Program Epidemiology Center-Durham, Durham Veterans Affairs Medical Center Durham, Durham, NC; Medical University of South Carolina, Charleston, SC; Harvard Medical School; Dana-Farber Cancer Institute; and Brigham and Women's Hospital, Boston, MA.
authors.forename: John Z
authors.initials: JZ
authors.lastname: Ayanian
authors.affiliation: Duke Cancer Institute; Center for Learning Health Care, Duke Clinical Research Institute; Duke University Medical Center; Cooperative Studies Program Epidemiology Center-Durham, Durham Veterans Affairs Medical Center Durham, Durham, NC; Medical University of South Carolina, Charleston, SC; Harvard Medical School; Dana-Farber Cancer Institute; and Brigham and Women's Hospital, Boston, MA.
authors.forename: Dawn
authors.initials: D
authors.lastname: Provenzale
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000191:economics* / Q000453:epidemiology / Q000523:psychology*; D017281:Cost of Illness; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000191:economics* / Q000453:epidemiology / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D010465:Perception; D011446:Prospective Studies; D011787:Quality of Health Care; D011788:Quality of Life; D012720:Severity of Illness Index; D017741:Survivors