Financial toxicity is increasingly recognised as a concern for cancer survivors. While most research focusses on the impact of cost of treatment on financial toxicity, less is known about the relationship between employment and financial toxicity. We examined a large cross sectional cohort of survivors to evaluate the relationship between financial toxicity, employment and quality of life (QoL).
The study was a secondary analysis of a cohort of 2931 working- age (18-65 years at diagnosis) cancer survivors from the Patient Reported Outcomes Following Initial treatment and Long term Evaluation of Survivorship (PROFILES) registry in the Netherlands. Chi square, Fishers exact, Kruskal Wallis and Mann Whitney U tests were used to examine the relationship between financial toxicity and employment and QoL. Multivariate logistic regression examined demographic and clinical predictors of financial toxicity.
The mean age of participants was 55.3 with an equal gender split (females-50.2%). Median time from diagnosis was 3 years (min 0- max 20). Nearly half of participants (48.8%) were employed and the majority (78.1%) reported no financial difficulties. Financial problems were associated with not being in paid employment and having lower quality of life (both p<0.001). In multivariate analyses, financial toxicity was less likely among individuals who were employed, older, highly educated, female or married. Having had colorectal cancer was least likely to be associated with financial problems than other cancer types.
Despite the long time elapsed from diagnosis and the universal health care system available in the Netherlands, financial toxicity is a significant concern for a proportion of cancer survivors. Lack of employment was identified as a significant risk factor for financial toxicity. There is a need for further research into interventions to identify and manage employment loss and financial toxicity in cancer patients.