Skip to main content
SpringerLink
Log in

Age and gender differences in financial distress among hematopoietic cell transplant survivors

  • Original Article
  • Published:
Supportive Care in Cancer Aims and scope Submit manuscript

Abstract

Purpose

Cancer has long-term financial consequences. Adolescent and young adult (AYA) and middle-aged cancer survivors may experience more financial toxicity than older adults. This study examined age differences in financial distress in hematopoietic cell transplant survivors and whether these differences result from measurement bias, more financial barriers to care, or an overall higher level of distress.

Methods

Hematologic malignancy survivors (n = 1135, 2–10 years post-transplant) completed the Cancer and Treatment Distress Scale (CTXD) and demographics as part of the baseline assessment for a randomized clinical trial. The CTXD has seven subscales, but for this study, we examined the financial distress subscale and the overall score. Item response theory analyses tested for bias by age and gender. Multivariate linear regression tested the association of age and gender with the CTXD scores while controlling for financial barriers to care.

Results

No bias was found on the CTXD. AYA (p < 0.01) and middle-aged adults (p < 0.001) reported more financial and overall distress than older (age 65+) adults. The same association of age and financial distress was observed in women (p < 0.01). However, only middle-aged men (p < 0.01) reported more financial and overall distress than older men; AYA men did not (p > 0.18). Financial barriers to care were not associated with financial or overall distress.

Conclusions

Part of the increase in financial distress with younger age may be due to a higher risk of general distress. Policy initiatives to control cancer costs should consider life stage and the unique financial challenges at different ages for men and women.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Data availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

References

  1. Dieleman JL, Squires E, Bui AL, Campbell M, Chapin A, Hamavid H, Horst C, Li Z, Matyasz T, Reynolds A, Sadat N, Schneider MT, Murray CJL (2017) Factors associated with increases in US health care spending, 1996–2013. JAMA 318(17):1668–1678

    PubMed  PubMed Central  Google Scholar 

  2. Anderson GF, Reinhardt UE, Hussey PS, Petrosyan V (2003) It’s the prices, stupid: why the United States is so different from other countries. Health Aff (Millwood) 22(3):89–105

    Google Scholar 

  3. Morgan SG, Lee A (2017) Cost-related non-adherence to prescribed medicines among older adults: a cross-sectional analysis of a survey in 11 developed countries. BMJ Open 7(1):e014287

    PubMed  PubMed Central  Google Scholar 

  4. Hennessy D, Sanmartin C, Ronksley P, Weaver R, Campbell D, Manns B, Tonelli M, Hemmelgarn B (2016) Out-of-pocket spending on drugs and pharmaceutical products and cost-related prescription non-adherence among Canadians with chronic disease. Health Rep 27(6):3–8

    PubMed  Google Scholar 

  5. Litwin H, Sapir EV (2009) Forgone health care due to cost among older adults in European countries and in Israel. Eur J Ageing 6(3):167–176

    PubMed  PubMed Central  Google Scholar 

  6. Hossein Z, Gerard A (2013) Trends in cost sharing among selected high income countries—2000–2010. Health Policy 112(1–2):35–44

    PubMed  Google Scholar 

  7. Saito AM, Cutler C, Zahrieh D, Soiffer RJ, Ho VT, Alyea EP, Koreth J, Antin JH, Lee SJ (2008) Costs of allogeneic hematopoietic cell transplantation with high-dose regimens. Biol Blood Marrow Transplant 14(2):197–207

    PubMed  PubMed Central  Google Scholar 

  8. Khera N, Chang YH, Hashmi S, Slack J, Beebe T, Roy V, Noel P, Fauble V, Sproat L, Tilburt J, Leis JF, Mikhael J (2014) Financial burden in recipients of allogeneic hematopoietic cell transplantation. Biol Blood Marrow Transplant 20(9):1375–1381

    PubMed  Google Scholar 

  9. Azzani M, Roslani AC, Su TT (2015) The perceived cancer-related financial hardship among patients and their families: a systematic review. Support Care Cancer 23(3):889–898

    PubMed  Google Scholar 

  10. Yabroff KR, Dowling EC, Guy GP Jr, Banegas MP, Davidoff A, Han X, Virgo KS, McNeel T, Chawla N, Blanch-Hartigan D, Kent EE, Li C, Rodriguez JL, de Moor JS, Zheng Z, Jemal A, Ekwueme DU (2016) Financial hardship associated with cancer in the United States: findings from a population-based sample of adult cancer survivors. J Clin Oncol 34(3):259–267

    PubMed  Google Scholar 

  11. Kale HP, Carroll NV (2016) Self-reported financial burden of cancer care and its effect on physical and mental health-related quality of life among US cancer survivors. Cancer 122(8):283–289

    PubMed  Google Scholar 

  12. Jagsi R, Pottow JA, Griffith KA, Bradley C, Hamilton AS, Graff J, Katz SJ, Hawley ST (2014) Long-term financial burden of breast cancer: experiences of a diverse cohort of survivors identified through population-based registries. J Clin Oncol 32(12):1269–1276

    PubMed  PubMed Central  Google Scholar 

  13. Huntington SF, Weiss BM, Vogl DT, Cohen AD, Garfall AL, Mangan PA, Doshi JA, Stadtmauer EA (2015) Financial toxicity in insured patients with multiple myeloma: a cross-sectional pilot study. Lancet Haematol 2(10):e408–e416

    PubMed  Google Scholar 

  14. Bestvina CM et al (2014) Patient-oncologist cost communication, financial distress, and medication adherence. J Oncol Pract 10(3):162–167

    PubMed  Google Scholar 

  15. Sharp L, Carsin AE, Timmons A (2013) Associations between cancer-related financial stress and strain and psychological well-being among individuals living with cancer. Psychooncology 22(4):745–755

    PubMed  Google Scholar 

  16. Ell K, Xie B, Wells A, Nedjat-Haiem F, Lee PJ, Vourlekis B (2008) Economic stress among low-income women with cancer: effects on quality of life. Cancer 112(3):616–625

    PubMed  Google Scholar 

  17. Hamilton JG, Wu LM, Austin JE, Valdimarsdottir H, Basmajian K, Vu A, Rowley SD, Isola L, Redd WH, Rini C (2013) Economic survivorship stress is associated with poor health-related quality of life among distressed survivors of hematopoietic stem cell transplantation. Psychooncology 22(4):911–921

    PubMed  Google Scholar 

  18. Lathan CS, Cronin A, Tucker-Seeley R, Zafar SY, Ayanian JZ, Schrag D (2016) Association of financial strain with symptom burden and quality of life for patients with lung or colorectal cancer. J Clin Oncol 34(15):1732–1740

    CAS  PubMed  PubMed Central  Google Scholar 

  19. Ramsey SD, Bansal A, Fedorenko CR, Blough DK, Overstreet KA, Shankaran V, Newcomb P (2016) Financial insolvency as a risk factor for early mortality among patients with cancer. J Clin Oncol 34(9):980–986

    CAS  PubMed  PubMed Central  Google Scholar 

  20. Ramsey SD, Howlader N, Etzioni RD, Donato B (2004) Chemotherapy use, outcomes, and costs for older persons with advanced non-small-cell lung cancer: evidence from Surveillance, Epidemiology and End Results–Medicare. J Clin Oncol 22(24):4971–4978

    PubMed  Google Scholar 

  21. Rogowski J, Lillard LA, Kington R (1997) The financial burden of prescription drug use among elderly persons. Gerontologist 37(4):475–482

    CAS  PubMed  Google Scholar 

  22. Banegas MP, Yabroff KR, O'Keeffe-Rosetti MC, Ritzwoller DP, Fishman PA, Salloum RG, Lafata JE, Hornbrook MC (2018) Medical care costs associated with cancer in integrated delivery systems. J Natl Compr Cancer Netw 16(4):402–410

    Google Scholar 

  23. Ramsey S, Blough D, Kirchhoff A, Kreizenbeck K, Fedorenko C, Snell K, Newcomb P, Hollingworth W, Overstreet K (2013) Washington state cancer patients found to be at greater risk for bankruptcy than people without a cancer diagnosis. Health Aff (Millwood) 32(6):1143–1152

    Google Scholar 

  24. Hjermstad MJ, Fayers PM, Bjordal K, Kaasa S (1998) Using reference data on quality of life—the importance of adjusting for age and gender, exemplified by the EORTC QLQ-C30 (+3). Eur J Cancer 34(9):1381–1389

    CAS  PubMed  Google Scholar 

  25. Knight JM, Syrjala KL, Majhail NS, Martens M, le-Rademacher J, Logan BR, Lee SJ, Jacobsen PB, Wood WA, Jim HSL, Wingard JR, Horowitz MM, Abidi MH, Fei M, Rawls L, Rizzo JD (2016) Patient-reported outcomes and socioeconomic status as predictors of clinical outcomes after hematopoietic stem cell transplantation: a study from the Blood and Marrow Transplant Clinical Trials Network 0902 trial. Biol Blood Marrow Transplant 22(12):2256–2263

    PubMed  PubMed Central  Google Scholar 

  26. Syrjala KL et al (2018) Engagement with INSPIRE, an online program for hematopoietic cell transplantation survivors. Biol Blood Marrow Transplant 24:1692

    PubMed  PubMed Central  Google Scholar 

  27. Syrjala KL, Sutton SK, Jim HS, Knight JM, Wood WA, Lee SJ, Jacobsen PB, Abidi MH, Yi JC (2017) Cancer and treatment distress psychometric evaluation over time: a BMT CTN 0902 secondary analysis. Cancer 123(8):1416–1423

    PubMed  Google Scholar 

  28. Syrjala KL, Yi JC, Langer SL (2016) Psychometric properties of the Cancer and Treatment Distress (CTXD) measure in hematopoietic cell transplantation patients. Psychooncology 25(5):529–535

    PubMed  Google Scholar 

  29. Syrjala KL (2016) Scoring manual for the Cancer and Treatment Distress (CTXD) Scale. Fred Hutchinson Cancer Research Center, Seattle

    Google Scholar 

  30. Majhail NS et al (2018) Randomized controlled trial of individualized treatment summary and survivorship care plans for hematopoietic cell transplantation survivors. Haematologica 104:1084

    PubMed  Google Scholar 

  31. Samejima F (1969) Estimation of a latent ability using a response pattern of graded scores. Psychometrika 34(suppl 4)

  32. Lord FM (1977) A study of item bias, using item characteristic curve theory. In: Portinga YH (ed) Basic problems in cross-cultural psychology. Swets and Zeitlinger, Amsterdam, pp 19–29

    Google Scholar 

  33. Benjamini Y, Hochberg Y (1995) Controlling the false discovery rate: a practical and powerful approach to multiple testing. J R Stat Soc Ser B 57:289–300

    Google Scholar 

  34. Thissen D, Steinberg L, Kuang D (2002) Quick and easy implementation of the Benjamini-Hochberg procedure for controlling the false positive rate in multiple comparisons. J Educ Behav Stat 27(1):77–83

    Google Scholar 

  35. Meeker CR et al (2016) Relationships among financial distress, emotional distress, and overall distress in insured patients with cancer. J Oncol Pract 12(7):e755–e764

    PubMed  PubMed Central  Google Scholar 

  36. Jones SMW, Nguyen T, Chennupati S Association of financial burden with self-rated and mental health in older adults with cancer. J Aging Health In Press

  37. Yabroff KR, Zhao J, Han X, Zheng Z (2019) Prevalence and correlates of medical financial hardship in the USA. J Gen Intern Med 34(8):1494–1502

    PubMed  Google Scholar 

  38. Stone AA, Schwartz JE, Broderick JE, Deaton A (2010) A snapshot of the age distribution of psychological well-being in the United States. Proc Natl Acad Sci U S A 107(22):9985–9990

    CAS  PubMed  PubMed Central  Google Scholar 

  39. Urry HL, Gross JJ (2010) Emotion regulation in older age. Curr Dir Psychol Sci 19(6):352–357

    Google Scholar 

  40. Grundy E, Henretta JC (2006) Between elderly parents and adult children: a new look at the intergenerational care provided by the ‘sandwich generation’. Aging Soc 26:707–722

    Google Scholar 

  41. Spillman BC, Pezzin LE (2000) Potential and active family caregivers: changing networks and the “sandwich generation”. Milbank Q 78(3):347–374 table of contents

    CAS  PubMed  PubMed Central  Google Scholar 

  42. Geue K, Sender A, Schmidt R, Richter D, Hinz A, Schulte T, Brähler E, Stöbel-Richter Y (2014) Gender-specific quality of life after cancer in young adulthood: a comparison with the general population. Qual Life Res 23(4):1377–1386

    PubMed  Google Scholar 

  43. Income. In Merriam-Webster. 2019, Merriam-Webster

  44. Wealth. In Merriam-Webster. 2019, Merriam Webster

  45. Sierminska EM, Frick JR, Grabka MM (2010) Examining the gender wealth gap. Oxf Econ Pap 62(4):669–690

    Google Scholar 

  46. Tichelli A et al (2017) Inability to work and need for disability pension among long-term survivors of hematopoietic stem cell transplantation. Bone Marrow Transplant 52(10):1436–1442

    CAS  PubMed  Google Scholar 

  47. Kirchhoff AC, Leisenring W, Syrjala KL (2010) Prospective predictors of return to work in the 5 years after hematopoietic cell transplantation. J Cancer Surviv 4(1):33–44

    PubMed  PubMed Central  Google Scholar 

  48. National Cancer Institute (ed) (2017) Financial toxicity and cancer treatment (PDQ®)—health professional version. National Cancer Institute, Bethesda

    Google Scholar 

Download references

Funding

This research was funded by the National Institutes of Health, National Cancer Institute (NIH/NCI) grant R01 CA160684 and R01 CA215134. This work was also in part supported by grants from the NIH/NCI, CA112631 and CA18029, and through the NIH/NCI Cancer Center Support Grant P30 CA015704.

Author information

Authors and Affiliations

  1. Fred Hutchinson Cancer Research Center, Seattle, WA, USA

    Salene M. W. Jones, Jean C. Yi, Wendy M. Leisenring, Mary E. D. Flowers, Stephanie J. Lee & Karen L. Syrjala

  2. Moffitt Cancer Center, Tampa, FL, USA

    Heather S. L. Jim

  3. University of Pennsylvania, Philadelphia, PA, USA

    Alison W. Loren

  4. Cleveland Clinic, Cleveland, OH, USA

    Navneet S. Majhail

  5. Barbara Ann Karmanos Cancer Institute, Detroit, MI, USA

    Joseph Uberti

  6. University of Nebraska, Omaha, NB, USA

    Victoria Whalen

  7. University of Washington School of Medicine, 1100 Fairview Ave N, D5-220, Seattle, WA, 98109, USA

    Mary E. D. Flowers, Stephanie J. Lee & Karen L. Syrjala

Authors
  1. Salene M. W. Jones
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jean C. Yi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Heather S. L. Jim
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Alison W. Loren
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Navneet S. Majhail
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Joseph Uberti
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Victoria Whalen
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Wendy M. Leisenring
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Mary E. D. Flowers
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Stephanie J. Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Karen L. Syrjala
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Karen L. Syrjala.

Ethics declarations

Conflict of interest

The authors do not have any financial conflicts of interest to disclose.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in this study.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Jones, S.M.W., Yi, J.C., Jim, H.S.L. et al. Age and gender differences in financial distress among hematopoietic cell transplant survivors. Support Care Cancer 28, 4361–4371 (2020). https://doi.org/10.1007/s00520-019-05291-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00520-019-05291-1

Keywords

Search

Navigation