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Financial Impact of Colorectal Cancer and Its Consequences: Associations between Cancer-Related Financial Stress and Strain and Health-Related Quality of Life

Lookup NU author(s): Professor Linda Sharp



This is the authors' accepted manuscript of an article that has been published in its final definitive form by Lippincott Williams and Wilkins, 2018.

For re-use rights please refer to the publisher's terms and conditions.


© 2017 The American Society of Colon and Rectal Surgeons, Inc.BACKGROUND: The financial impact and consequences of cancer on the lives of survivors remain poorly understood. This is especially true for colorectal cancer. OBJECTIVE: We investigated objective cancer-related financial stress, subjective cancer-related financial strain, and their association with health-related quality of life in colorectal cancer survivors. DESIGN: This was a cross-sectional postal survey. SETTINGS: The study was conducted in Ireland, which has a mixed public-private healthcare system. PATIENTS: Colorectal cancer survivors, diagnosed 6 to 37 months prior, were identified from the population-based National Cancer Registry. MAIN OUTCOME MEASURES: Cancer-related financial stress was assessed as impact of cancer on household ability to make ends meet and cancer-related financial strain by feelings about household financial situation since cancer diagnosis. Health-related quality of life was based on European Organisation for Research and Treatment of Cancer QLQ-C30 global health status. Logistic regression was used to identify associations between financial stress and strain and low health-related quality of life (lowest quartile, score ≤50). RESULTS: A total of 493 survivors participated. Overall, 41% reported cancer-related financial stress and 39% cancer-related financial strain; 32% reported both financial stress and financial strain. After adjustment for sociodemographic and clinical variables, the odds of low health-related quality of life were significantly higher in those who reported cancer-related financial stress postdiagnosis compared with those who reported no change in financial stress postcancer (OR = 2.54 (95% CI, 1.62-3.99)). The odds of low health-related quality of life were also significantly higher in those with worse financial strain postdiagnosis (OR =1.73 (95% CI, 1.09-2.72)). The OR for those with both cancer-related financial stress and financial strain was 2.59 (95% CI, 1.59-4.22). LIMITATIONS: Survey responders were younger, on average, than nonresponders. Responders and nonresponders may have differed in cancer-related financial stress and strain or health-related quality of life. CONCLUSIONS: Four in 10 colorectal cancer survivors reported an adverse financial impact of cancer. Cancer-related financial stress and strain were significantly associated with low health-related quality of life. To inform support strategies, additional research is needed to better understand how both objective and subjective financial distress influence survivors' health-related quality of life. See Video Abstract

Publication metadata

Author(s): Sharp L, O'Leary E, O'Ceilleachair A, Skally M, Hanly P

Publication type: Article

Publication status: Published

Journal: Diseases of the Colon and Rectum

Year: 2018

Volume: 61

Issue: 1

Pages: 27-35

Print publication date: 01/01/2018

Acceptance date: 02/04/2016

Date deposited: 15/01/2018

ISSN (print): 0012-3706

ISSN (electronic): 1530-0358

Publisher: Lippincott Williams and Wilkins


DOI: 10.1097/DCR.0000000000000923

PubMed id: 29219919


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