Elsevier

Gynecologic Oncology

Volume 124, Issue 3, March 2012, Pages 437-443
Gynecologic Oncology

Does economic burden influence quality of life in breast cancer survivors?

https://doi.org/10.1016/j.ygyno.2011.11.038Get rights and content

Abstract

Goals

Economic burden is emerging as a crucial dimension in our understanding of adjustment to cancer during treatment. Yet, economic burden is rarely examined in cancer survivorship. The goal of this paper is to describe the effect of economic hardship and burden among women with breast cancer.

Methods

We examined baseline and follow-up (3 and 6 month) data reported by 132 stage I and II breast cancer survivors assigned to the Wait Control arm of the Breast Cancer Education Intervention (BCEI), a clinical trial of education and support interventions. Repeated measures models fitted with linear mixed models were used to examine relationships between aspects of economic burden and overall quality of life (QOL) scores. Structural equation models (SEM) were used to examine the relationship between overall economic burden and QOL.

Results

Nineteen economic events were reported. The proportion of survivors who reported increase in insurance premiums increased in the 6-month study period (p = .022). The proportion of survivors reporting change in motivation (p = .016), productivity (p = .002), quality of work (p = .01), days missed from work (p < .001) and sacrificing other things (p = .001) declined. An increase in economic events was significantly associated with poorer quality of life at each of the study time points.

Conclusion

Economic burden of breast cancer extends into post-treatment survivorship. Better understanding of economic impact and managing economic burden may help maintain QOL.

Highlights

► Economic burden is emerging as a crucial dimension in cancer survivorship, but is rarely examined. ► We explored economic burden among 132 breast cancer survivors in the BCEI over a six month period. ► Survivors reported increase in insurance premiums in the 6 month period. ► An increase in economic events was associated with poorer quality of life.

Introduction

About 2.5 million women in the United States are living with a history of breast cancer [1]. Survival from breast cancer is high with 89% survival at 5 years [2]. While cancer survivorship care plans often include information about cancer surveillance, health maintenance, and psychosocial care [3], [4], [5], economic burden and financial distress are not well described. Yet, economic burden is emerging as a crucial dimension in our understanding of cancer and cancer survivorship [6], [7], [8], [9].

Economic burden is defined as “the loss of economic resources and opportunities associated with the occurrence of cancer” [6], [10]. Loss of economic resources may lead to reduction in income or change in economic lifestyle, need to borrow money, depletion of savings, declaring bankruptcy, sacrificing family plans, and other troublesome events. Loss of opportunities may lead to difficulty in keeping or finding a job, and decreased productivity and quality of work [11]. Since economic burden may be associated with changes in quality of life (QOL), we collected economic data within the Breast Cancer Education Intervention (BCEI), a randomized trial of quality of life psychoeducational support interventions for breast cancer survivors. In this paper, we conducted a secondary analysis of economic burden and its relationship to QOL among early stage breast cancer survivors in the Wait Control arm of the BCEI.

Section snippets

Study participants

Data from 132 early-stage breast cancer survivors, enrolled in the Wait Control arm of the BCEI, a randomized trial of quality of life psychoeducational support interventions for breast cancer survivors in the first year after primary treatment, were used in this study. The overall design and goals of the BCEI were previously published [12]. Briefly, breast cancer survivors were recruited from a regional cancer center and private oncology offices in the Southeastern United States. Eligible

Results

A total of 132 breast cancer survivors were included in the present analyses. Data from only one participant were missing at Month 6. Table 1 shows participants' baseline socio-demographic and treatment characteristics. The modal participant was Caucasian, between 46 and 65 years of age, married, having some college education, working full time, with a family income of more than $50,000. The majority of survivors were within the first year of diagnosis, received combined lumpectomy and radiation

Discussion

In this group of mainly insured breast cancer survivors, we found that in the six month period following completion of breast cancer treatment, more than 50% reported at least one economic burden event related to either work or financial hardship. More than a quarter reported changes in income or sacrificing things like family plans over a 6 month period, and among those who worked, more than 15% reported changes in motivation, productivity or quantity (missed days) of work. These events, in

Conclusion

Economic burden is an essential component that contributes to our understanding of cancer survivorship, and provides a glimpse into the everyday life and financial pressure facing breast cancer survivors. This analysis provides additional evidence that economic burden associated with breast cancer treatment continues into post-treatment survivorship. Future interventions for other cancer survivors that include a discussion about economic impact of cancer, and ways to manage economic burden may

Financial disclosure

None.

Conflict of interest statement

The authors declare that there are no conflicts of interest.

Acknowledgment

Grant support from the National Institute of Nursing Research (NINR) and the Office of Cancer Survivorship at the National Cancer Institute (#5R01NR5332).

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