Distress and Financial Distress in Adults With Cancer: An Age-Based Analysis

Abstract

Background: Although financial distress is commonly recognized in patients with cancer, it may be more prevalent in younger adults. This study sought to evaluate disparities in overall and financial distress in patients with cancer as a function of age. Methods: This was a single-center cross-sectional study of patients with solid malignancies requiring cancer therapy. The patient questionnaire included demographics, financial concerns, and measures of overall and financial distress. Data analyses compared patients in 3 age groups: young (<50 years), middle-aged (50-64 years), and elderly (≥65 years). Results: The cohort included 119 patients (median age, 62 years; 52% female; 84% white; 100% insured; 36% income ≥$75,000). Significant financial concerns included paying rent/mortgage (P=.003) and buying food (P=.032). Impact of Event Scale (IES) results revealed significant distress in 73% young, 64% middle-aged, and 44% elderly patients. The mean Distress Thermometer (DT) score was 6.1 (standard deviation [SD], 2.9) for young patients, 5.4 (SD, 2.6) for middle-aged, and 4.4 (SD, 3.3) for elderly patients. Young patients were more likely than elderly patients to have a higher IES distress score (P=.016) and DT score (P=.048). The mean InCharge score was lowest (indicating greatest financial distress) in the young group and progressed with age: 5.0 (SD, 1.9), 5.7 (SD, 2.7), and 7.4 (SD, 1.9), respectively (P<.001). Multivariable analyses revealed that the relationship between financial distress and overall distress was strongest in the middle-age group; as the DT increased by 1 point, the InCharge scores decreased by 0.52 (P<.001). Conclusions: Overall and financial distress are more common in young and middle-aged patients with cancer. There are several factors, including employment, insurance, access to paid sick leave, children, and education, that affect younger and middle-aged adults and are less of a potential stressor for elderly individuals.

Conflict of interest statement

Author’s Disclosures of Potential Conflicts of Interest: No authors report any conflict of interest.

Conflict of Interest: The authors declare that they have no conflict of interest.

Copyright © 2017 by the National Comprehensive Cancer Network.

Figures

Figure 1.. Comparisons of significant results on distress and financial distress measures by age

Note: Breakdown of percentage of patients in the younger, middle age, and older group who met or exceeded the cutoff for each instrument. NCCN DT [National Comprehensive Cancer Network Distress Thermometer]: scores of 4 and greater are indicative of significant distress. IES [Impact of Events Scale]: scores of 26 and greater indicate significant distress. InCharge [InCharge Financial Distress and Financial Well-being Scale]: scores of 4.0 and less indicate financial distress.

Figure 2:. InCharge Financial Distress and Financial Well-being Scale Scores

Note: The percent of patients whose averaged score fell in each decile are presented in this figure, separated by age: <50 years old, 50–64 years old, ≥65 years old. Raw calculated scores are divided by 8 (# of questions) to determine the average score, which is presented to 1 decimal point. Scores up to and including 4.0 represent financial distress. Normative descriptors are displayed to label each decile of scores.

Figure 3.. Association between financial distress (InCharge) and distress (Distress Thermometer) by age

For each one point increase in Distress Thermometer (indicating increased distress), the financial distress score fell (indicating increased financial distress) at various rates based on age. The most significant results were in the middle-age group: the association between InCharge and Distress Thermometer was significant at p