title: Financial Distress and Its Associations With Physical and Emotional Symptoms and Quality of Life Among Advanced Cancer Patients.
abstract: OBJECTIVE
  There are limited data on the effects of financial distress (FD) on overall suffering and quality of life (QOL) of patients with advanced cancer (AdCa). In this cross-sectional study, we examined the frequency of FD and its correlates in AdCa.
  
  
  METHODS
  We interviewed 149 patients, 77 at a comprehensive cancer center (CCC) and 72 at a general public hospital (GPH). AdCa completed a self-rated FD (subjective experience of distress attributed to financial problems) numeric rating scale (0 = best, 10 = worst) and validated questionnaires assessing symptoms (Edmonton Symptom Assessment System [ESAS]), psychosocial distress (Hospital Anxiety and Depression Scale [HADS]), and QOL (Functional Assessment of Cancer Therapy-General [FACT-G]).
  
  
  RESULTS
  The patients' median age was 60 years (95% confidence interval [CI]: 58.6-61.5 years); 74 (50%) were female; 48 of 77 at CCC (62%) versus 13 of 72 at GPH (18%) were white; 21 of 77 (27%) versus 32 of 72 (38%) at CCC and GPH, respectively, were black; and 7 of 77 (9%) versus 27 of 72 (38%) at CCC and GPH, respectively, were Hispanic (p < .0001). FD was present in 65 of 75 at CCC (86%; 95% CI: 76%-93%) versus 65 of 72 at GPH (90%; 95% CI: 81%-96%; p = .45). The median intensity of FD at CCC and GPH was 4 (interquartile range [IQR]: 1-7) versus 8 (IQR: 3-10), respectively (p = .0003). FD was reported as more severe than physical distress, distress about physical functioning, social/family distress, and emotional distress by 45 (30%), 46 (31%), 64 (43%), and 55 (37%) AdCa, respectively (all significantly worse for patients at GPH) (p < .05). AdCa reported that FD was affecting their general well-being (0 = not at all, 10 = very much) with a median score of 5 (IQR: 1-8). FD correlated (Spearman correlation) with FACT-G (r = -0.23, p = .0057); HADS-anxiety (r = .27, p = .0014), ESAS-anxiety (r = .2, p = .0151), and ESAS-depression (r = .18, p = .0336).
  
  
  CONCLUSIONS
  FD was very frequent in both groups, but median intensity was double among GPH patients. More than 30% of AdCa rated FD to be more severe than physical, family, and emotional distress. More research is needed to better characterize FD and its correlates in AdCa and possible interventions.
  
  
  CONCLUSIONS
  Financial distress is an important and common factor contributing to the suffering of advanced cancer patients and their caregivers. It should be suspected in patients with persistent, refractory symptom expression. Early identification, measurement, and documentation will allow clinical teams to develop interventions to improve financial distress and its impact on quality of life of advanced cancer patients.
authors.affiliation: Departments of Palliative Care and Rehabilitation Medicine, General Oncology, and Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; The University of Texas Health Science, Medical School, Division of Geriatrics and Palliative Medicine, Lyndon B. Johnson General Hospital, Harris Health System, Houston, Texas, USA; Centre de Soins Palliatifs, Centre Hospitalier de Lyon Sud, Hospices Civils de Lyon, Lyon, France marvin.delgado@mdanderson.org.
authors.forename: Marvin
authors.initials: M
authors.lastname: Delgado-Guay
authors.affiliation: Departments of Palliative Care and Rehabilitation Medicine, General Oncology, and Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; The University of Texas Health Science, Medical School, Division of Geriatrics and Palliative Medicine, Lyndon B. Johnson General Hospital, Harris Health System, Houston, Texas, USA; Centre de Soins Palliatifs, Centre Hospitalier de Lyon Sud, Hospices Civils de Lyon, Lyon, France.
authors.forename: Jeanette
authors.initials: J
authors.lastname: Ferrer
authors.affiliation: Departments of Palliative Care and Rehabilitation Medicine, General Oncology, and Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; The University of Texas Health Science, Medical School, Division of Geriatrics and Palliative Medicine, Lyndon B. Johnson General Hospital, Harris Health System, Houston, Texas, USA; Centre de Soins Palliatifs, Centre Hospitalier de Lyon Sud, Hospices Civils de Lyon, Lyon, France.
authors.forename: Alyssa G
authors.initials: AG
authors.lastname: Rieber
authors.affiliation: Departments of Palliative Care and Rehabilitation Medicine, General Oncology, and Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; The University of Texas Health Science, Medical School, Division of Geriatrics and Palliative Medicine, Lyndon B. Johnson General Hospital, Harris Health System, Houston, Texas, USA; Centre de Soins Palliatifs, Centre Hospitalier de Lyon Sud, Hospices Civils de Lyon, Lyon, France.
authors.forename: Wadih
authors.initials: W
authors.lastname: Rhondali
authors.affiliation: Departments of Palliative Care and Rehabilitation Medicine, General Oncology, and Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; The University of Texas Health Science, Medical School, Division of Geriatrics and Palliative Medicine, Lyndon B. Johnson General Hospital, Harris Health System, Houston, Texas, USA; Centre de Soins Palliatifs, Centre Hospitalier de Lyon Sud, Hospices Civils de Lyon, Lyon, France.
authors.forename: Supakarn
authors.initials: S
authors.lastname: Tayjasanant
authors.affiliation: Departments of Palliative Care and Rehabilitation Medicine, General Oncology, and Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; The University of Texas Health Science, Medical School, Division of Geriatrics and Palliative Medicine, Lyndon B. Johnson General Hospital, Harris Health System, Houston, Texas, USA; Centre de Soins Palliatifs, Centre Hospitalier de Lyon Sud, Hospices Civils de Lyon, Lyon, France.
authors.forename: Jewel
authors.initials: J
authors.lastname: Ochoa
authors.affiliation: Departments of Palliative Care and Rehabilitation Medicine, General Oncology, and Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; The University of Texas Health Science, Medical School, Division of Geriatrics and Palliative Medicine, Lyndon B. Johnson General Hospital, Harris Health System, Houston, Texas, USA; Centre de Soins Palliatifs, Centre Hospitalier de Lyon Sud, Hospices Civils de Lyon, Lyon, France.
authors.forename: Hilda
authors.initials: H
authors.lastname: Cantu
authors.affiliation: Departments of Palliative Care and Rehabilitation Medicine, General Oncology, and Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; The University of Texas Health Science, Medical School, Division of Geriatrics and Palliative Medicine, Lyndon B. Johnson General Hospital, Harris Health System, Houston, Texas, USA; Centre de Soins Palliatifs, Centre Hospitalier de Lyon Sud, Hospices Civils de Lyon, Lyon, France.
authors.forename: Gary
authors.initials: G
authors.lastname: Chisholm
authors.affiliation: Departments of Palliative Care and Rehabilitation Medicine, General Oncology, and Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; The University of Texas Health Science, Medical School, Division of Geriatrics and Palliative Medicine, Lyndon B. Johnson General Hospital, Harris Health System, Houston, Texas, USA; Centre de Soins Palliatifs, Centre Hospitalier de Lyon Sud, Hospices Civils de Lyon, Lyon, France.
authors.forename: Janet
authors.initials: J
authors.lastname: Williams
authors.affiliation: Departments of Palliative Care and Rehabilitation Medicine, General Oncology, and Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; The University of Texas Health Science, Medical School, Division of Geriatrics and Palliative Medicine, Lyndon B. Johnson General Hospital, Harris Health System, Houston, Texas, USA; Centre de Soins Palliatifs, Centre Hospitalier de Lyon Sud, Hospices Civils de Lyon, Lyon, France.
authors.forename: Susan
authors.initials: S
authors.lastname: Frisbee-Hume
authors.affiliation: Departments of Palliative Care and Rehabilitation Medicine, General Oncology, and Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; The University of Texas Health Science, Medical School, Division of Geriatrics and Palliative Medicine, Lyndon B. Johnson General Hospital, Harris Health System, Houston, Texas, USA; Centre de Soins Palliatifs, Centre Hospitalier de Lyon Sud, Hospices Civils de Lyon, Lyon, France.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Bruera
mesh_terms: D000342:Affective Symptoms / Q000191:economics* / Q000523:psychology*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications / Q000191:economics* / Q000523:psychology*; D011788:Quality of Life
keywords: Advanced cancer; Financial distress; Quality of life