title: Predictors of financial difficulties and work modifications among cancer survivors in the United States.
abstract: OBJECTIVE
  The aim of this study is to examine predictors of cancer-related financial difficulties and work modifications in a national sample of cancer survivors.
  
  
  METHODS
  Using the 2011 Medical Expenditure Panel Survey and Experiences with Cancer Survivorship Supplement, the prevalence of financial difficulties and work modifications was examined. Logistic regression and survey weights were used to model these outcomes as functions of sociodemographic and health covariates separately among survivors in active treatment and survivors under age 65 years.
  
  
  RESULTS
  Among all survivors, 33.2% reported any financial concern, with 17.9% reporting financial difficulties such as debt or bankruptcy. Among working survivors, 44.0% made any work modification and 15.3% made long-term work modifications (e.g., delayed or early retirement). Among those in active treatment, predictors of financial difficulty included: race/ethnicity other than white, non-Hispanic [OR = 8.0; 95% CI 2.2-28.4]; income <200% of federal poverty level (FPL) [OR = 15.7; 95% CI 2.6-95.2] or between 200 and 400% of FPL [OR = 8.2; 95% CI 1.3-51.4]; residence in a non-metropolitan service area [OR = 6.4; 95% CI 1.6-25.0]; and good/fair/poor self-rated health [OR = 3.8; 95% CI 1.0-14.2]. Among survivors under age 65 years, predictors of long-term work modifications included good/fair/poor self-rated health [OR = 4.1; 95% CI 1.6-10.2], being married [OR = 2.2; 95% CI 1.0-4.7], uninsured [OR = 3.5; 95% CI 1.3-9.3], or publicly insured [OR = 9.0; 95% CI 3.3-24.4].
  
  
  CONCLUSIONS
  A substantial proportion of cancer survivors experience cancer-related financial difficulties and work modifications, particularly those who report race/ethnicity other than white, non-Hispanic, residence in non-metropolitan areas, worse health status, lower income, and public or no health insurance.
  
  
  CONCLUSIONS
  Attention to the economic impact of cancer treatment is warranted across the survivorship trajectory, with particular attention to subgroups at higher risk.
authors.affiliation: Collaborative Cancer Care Research Group (3CRG), Betty Irene Moore School of Nursing, University of California, Davis, 4610 X Street #4202, Sacramento, CA, 95817, USA. rlwhitney@ucdavis.edu.
authors.forename: Robin L
authors.identifier: http://orcid.org/0000-0002-3883-8082
authors.initials: RL
authors.lastname: Whitney
authors.affiliation: Collaborative Cancer Care Research Group (3CRG), Betty Irene Moore School of Nursing, University of California, Davis, 4610 X Street #4202, Sacramento, CA, 95817, USA.
authors.forename: Janice F
authors.initials: JF
authors.lastname: Bell
authors.affiliation: Collaborative Cancer Care Research Group (3CRG), Betty Irene Moore School of Nursing, University of California, Davis, 4610 X Street #4202, Sacramento, CA, 95817, USA.
authors.forename: Sarah C
authors.initials: SC
authors.lastname: Reed
authors.affiliation: Collaborative Cancer Care Research Group (3CRG), Betty Irene Moore School of Nursing, University of California, Davis, 4610 X Street #4202, Sacramento, CA, 95817, USA.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Lash
authors.affiliation: Collaborative Cancer Care Research Group (3CRG), Betty Irene Moore School of Nursing, University of California, Davis, 4610 X Street #4202, Sacramento, CA, 95817, USA.|Comprehensive Cancer Center, UC Davis Health System, University of California, Davis, 4501 X Street, Sacramento, CA, 95817, USA.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Bold
authors.affiliation: Collaborative Cancer Care Research Group (3CRG), Betty Irene Moore School of Nursing, University of California, Davis, 4610 X Street #4202, Sacramento, CA, 95817, USA.
authors.forename: Katherine K
authors.initials: KK
authors.lastname: Kim
authors.affiliation: Collaborative Cancer Care Research Group (3CRG), Betty Irene Moore School of Nursing, University of California, Davis, 4610 X Street #4202, Sacramento, CA, 95817, USA.
authors.forename: Andra
authors.initials: A
authors.lastname: Davis
authors.affiliation: Collaborative Cancer Care Research Group (3CRG), Betty Irene Moore School of Nursing, University of California, Davis, 4610 X Street #4202, Sacramento, CA, 95817, USA.|Comprehensive Cancer Center, UC Davis Health System, University of California, Davis, 4501 X Street, Sacramento, CA, 95817, USA.
authors.forename: David
authors.initials: D
authors.lastname: Copenhaver
authors.affiliation: Collaborative Cancer Care Research Group (3CRG), Betty Irene Moore School of Nursing, University of California, Davis, 4610 X Street #4202, Sacramento, CA, 95817, USA.
authors.forename: Jill G
authors.initials: JG
authors.lastname: Joseph
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000191:economics* / Q000628:therapy; D017741:Survivors / Q000706:statistics & numerical data*; D014481:United States; D014942:Workers' Compensation / Q000191:economics*
keywords: Employment issues; Financial burden; Medical Expenditure Panel Survey; Survivorship