title: Pre-diagnosis employment status and financial circumstances predict cancer-related financial stress and strain among breast and prostate cancer survivors.
abstract: OBJECTIVE
  Cancer may have a significant financial impact on patients, but the characteristics that predispose patients to cancer-related financial hardship are poorly understood. We investigated factors associated with cancer-related financial stress and strain in breast and prostate cancer survivors in Ireland, which has a complex mixed public-private healthcare system.
  
  
  METHODS
  Postal questionnaires were distributed to 1373 people diagnosed with cancer 3-24 months previously identified from the National Cancer Registry Ireland. Outcomes were cancer-related financial stress (impact of cancer diagnosis on household ability to make ends meet) and financial strain (concerns about household financial situation since cancer diagnosis). Modified Poisson regression was used to estimate relative risks (RR) for factors associated with cancer-related financial stress and strain.
  
  
  RESULTS
  Seven hundred forty survivors participated (response rate = 54 %). Of the respondents, 48 % reported cancer-related financial stress and 32 % cancer-related financial strain. Compared to those employed at diagnosis, risk of cancer-related financial stress was significantly lower in those not working (RR = 0.71, 95 % CI 0.58-0.86) or retired (RR = 0.48, 95 % CI 0.34-0.68). It was significantly higher in those who had dependents; experienced financial stress pre-diagnosis; had a mortgage/personal loans; had higher direct medical out-of-pocket costs; and had increased household bills post-diagnosis. For cancer-related financial strain, significant associations were found with dependents, pre-diagnosis employment status and pre-diagnosis financial stress; risk was lower in those with higher direct medical out-of-pocket costs.
  
  
  CONCLUSIONS
  Cancer-related financial stress and strain are common. Pre-diagnosis employment status and financial circumstances are important predictors of post-diagnosis financial wellbeing. These findings could inform development of tools to identify patients/survivors most in need of financial advice and support.
authors.affiliation: National Cancer Registry, Building 6800, Kinsale Road, Cork, Ireland. linda.sharp@ncl.ac.uk.|Institute of Health & Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, Tyne and Wear, NE2 4AX, England, UK. linda.sharp@ncl.ac.uk.
authors.forename: Linda
authors.initials: L
authors.lastname: Sharp
authors.affiliation: National Cancer Registry, Building 6800, Kinsale Road, Cork, Ireland.
authors.forename: Aileen
authors.initials: A
authors.lastname: Timmons
mesh_terms: D000368:Aged; D001943:Breast Neoplasms / Q000191:economics* / Q000453:epidemiology / Q000401:mortality; D004651:Employment / Q000706:statistics & numerical data*; D005260:Female; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006801:Humans; D007494:Ireland / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011471:Prostatic Neoplasms / Q000191:economics* / Q000453:epidemiology / Q000401:mortality; D011795:Surveys and Questionnaires; D017741:Survivors / Q000706:statistics & numerical data*
keywords: Breast cancer; Finances; Financial difficulties; Financial strain; Financial stress; Prostate cancer