A team of scientists, including one from UNC, reports that three interrelated stressors – financial strain (for instance, due to costly medical care), changes in employment status and health insurance coverage- may reduce survivors’ mental and physical well-being. They recommend that clinicians and researchers regard these factors as chronic stressors and identify resources and skills to help survivors cope.
Compared with other cancer populations, patients who undergo a blood (hematopoietic) stem cell transplant may be more vulnerable to these economic stressors due to the lengthy and expensive nature of transplantation treatment and recovery.
Christine Rini, PhD, senior author of the study, says, ”What we found is that survivors with greater economic challenges related to their employment and their ability to make ends meet financially also had worse problems with their health and well-being, even after accounting for differences in age, income, and medical status. Financial stress was a particular problem. This is important because even though many people report having these kinds of challenges after transplant, they have been largely ignored as a potential contributor to poor post-treatment outcomes.
“We also found some evidence that the state of the economy influenced how survivors reacted to their economic challenges. Some survivors completed measures before the financial crisis in September, 2008, and other survivors completed measures afterward. After the crisis there was a profound shift in the economic well-being of many Americans. It became relatively common for people to have problems similar to those being experienced by survivors. After the crisis survivors’ economic challenges were less strongly associated with poor health and well-being than they had been before the crisis, even though the overall scope of the challenges did not differ. This finding highlights how important it is to understand survivors’ perceptions of their economic challenges, not just the objective severity of those challenges.”
Dr. Rini is a research associate professor of health behavior at the UNC Gillings School of Public Health and a member of UNC Lineberger.
The study was published online on May 18, 2012, in the journal Psycho-Oncology.
The study involved 181 blood stem cell transplant survivors who completed questionnaires and telephone interviews from 9-36 months post-transplant. They were asked questions about perceived financial, employment, and insurance stressors and health-related quality of life. Greater financial and employment stress were associated with poorer health-related quality of life measurements related to physical social, emotional, and functional well-being. Insurance issues were not strongly associated with these outcomes, perhaps because for many participating survivors much of the cost associated with a transplant was covered by insurance.
Funding for the study was provided by a grant from the American Cancer Society.
Other authors were from the National Cancer Institute, Bethesda, Maryland; Mount Sinai School of Medicine, New York, New York; William Paterson University, Wayne, New Jersey; and the Hackensack University Medical Center, Hackensack, New Jersey.