title: Self-reported financial burden of cancer care and its effect on physical and mental health-related quality of life among US cancer survivors.
abstract: BACKGROUND
  Cancer-related financial burden has been linked to cancer survivors (CS) forgoing/delaying medical care, skipping follow-up visits, and discontinuing medications. To the authors' knowledge, little is known regarding the effect of financial burden on the health-related quality of life of CS.
  
  
  METHODS
  The authors analyzed 2011 Medical Expenditure Panel Survey data. Financial burden was present if one of the following problems was reported: borrowed money/declared bankruptcy, worried about paying large medical bills, unable to cover the cost of medical care visits, or other financial sacrifices. The following outcomes were evaluated: Physical Component Score (PCS) and Mental Component Score (MCS) of the 12-Item Short-Form Health Survey (SF-12), depressed mood, psychological distress, and worry related to cancer recurrence. The authors also assessed the effect of the number of financial problems on these outcomes.
  
  
  RESULTS
  Of the 19.6 million CS analyzed, 28.7% reported financial burden. Among them, the average PCS (42.3 vs 44.9) and MCS (48.1 vs 52.1) were lower for those with financial burden versus those without. In adjusted analyses, CS with financial burden had significantly lower PCS (β = -2.45), and MCS (β = -3.05), had increased odds of depressed mood (odds ratio, 1.95), and were more likely to worry about cancer recurrence (odds ratio, 3.54). Survivors reporting ≥ 3 financial problems reported statistically significant and clinically meaningful differences (≥3 points) in the mean PCS and MCS compared with survivors without financial problems.
  
  
  CONCLUSIONS
  Cancer-related financial burden was associated with lower health-related quality of life, increased risk of depressed mood, and a higher frequency of worrying about cancer recurrence among CS.
authors.affiliation: Division of Pharmacoeconomics and Health Outcomes, School of Pharmacy, Virginia Commonwealth University, Richmond, Virginia.
authors.forename: Hrishikesh P
authors.initials: HP
authors.lastname: Kale
authors.affiliation: Division of Pharmacoeconomics and Health Outcomes, School of Pharmacy, Virginia Commonwealth University, Richmond, Virginia.
authors.forename: Norman V
authors.initials: NV
authors.lastname: Carroll
mesh_terms: D000328:Adult; D000368:Aged; D016009:Chi-Square Distribution; D017281:Cost of Illness; D003430:Cross-Sectional Studies; D005260:Female; D005102:Health Expenditures; D006304:Health Status; D006801:Humans; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D015999:Multivariate Analysis; D009369:Neoplasms / Q000191:economics* / Q000523:psychology / Q000628:therapy; D011788:Quality of Life; D018570:Risk Assessment; D057566:Self Report; D011795:Surveys and Questionnaires; D017741:Survivors / Q000523:psychology* / Q000706:statistics & numerical data; D014481:United States
keywords: bankruptcy; cancer; depression; financial burden; health-related quality of life (HRQOL); mental health; out-of-pocket costs; psychological; quality of life; stress