Financial hardship and mental health among cancer survivors during the COVID-19 pandemic: An analysis of the U.S. COVID Impact Survey

ABSTRACT

Background: Cancer survivors often experience financial hardship due to high costs associated with cancer treatment. Our objective was to (1) identify determinants of financial hardship, and to (2) evaluate the impact of financial hardship on mental health symptoms among cancer survivors during the COVID-19 pandemic. Methods: We used nationally representative data from the COVID-19 Household Impact Survey collected at three-time points April 20-26, May 4-10, and May 30th -June 8 th of 2020. Our primary exposure was cancer survivor status, based on participant's self-report of a cancer diagnosis (n=854, 7.1%). We defined financial hardship using the following question “Suppose you have an unexpected expense that costs $400. Based on your current financial situation, how would you pay for this expense?” Respondents were categorized as experiencing financial hardship if they chose the following options I wouldn't be able to pay for it right now;sell something;use a payday loan, deposit advance, or overdraft;borrow from a friend or family member. Chi-square (χ2 ) tests were used to compare reported financial hardship among cancer survivors to other U.S. adults. Multivariable Poisson regression was used to identify determinants of financial hardship among cancer survivors. We used multinomial logistic regression to evaluate associations of financial hardship on mental health symptoms of cancer survivors. Results: Eighteen percent of cancer survivors reported experiencing financial hardship. Cancer survivors aged 30-44 (44.8%) and 45-59 years (25.9%) more frequently reported financial hardship compared to adults without cancer (23.4%, 16.7%, respectively, χ2p<0.05). Compared to cancer survivors aged 60+ years, those aged 18-29 (aPR 2.54, 95% CI;1.51-4.28), 30-44 (aPR3.41, 95% CI2.26-5.16), and 45-59 years (aPR3.66, 95% CI2.26-5.16) were more likely to experience financial hardship. Cancer survivors on Medicaid (aPR 1.76, 95% CI 1.16-2.66) were more likely to experience financial hardship compared to their counterparts. Compared to those without a high school degree, cancer survivors with some college education (aPR 0.30, 95% CI 0.18-0.47) and with a ≥Baccalaureate degree (aPR0.05, 95% CI 0.02- 0.14) were less likely to experience financial hardship. Rural cancer survivors had 61% higher prevalence of financial hardship compared to urban residents (aPR 1.61, 95% CI1.00-2.58), however, suburban residents were less likely to experience financial hardship compared to cancer survivors living in urban areas (aPR 0.65, 95% CI0.44-0.98). Cancer survivors who experienced financial hardship were more likely to report feeling depressed (aOR 2.78, 95% CI 1.39-5.56), lonely (aOR 3.06, 95% CI 1.39-6.72), and hopeless (aOR 3.16, 95% CI 1.36-7.37) 3-7 days during the last 7 days. Conclusion: Lower SES measures and younger age were determinants of experiencing financial hardship among cancer survivors. During the COVID-19 pandemic, there is a high burden of mental health symptoms among cancer survivors experiencing financial hardship.