Abstract A120: Financial well-being and quality of life following a cancer diagnosis: A focus on socioeconomic disparities
Authors: McDougall Jean A. , Anderson Jessica , Jaffe Shoshana Adler , Wiggins Charles L. , Meisner Angela L. , Guest Dolores D. , Sussman Andrew L. , Pankratz V. Shane 
Published: September 2020

Abstract
Background: Financial well-being (FWB) is defined by an individual’s ability to fully meet current and ongoing financial obligations, secure their financial future, and make choices that allow them to enjoy life. High out-of-pocket costs, and lost income following a cancer diagnosis and treatment, are associated with negative financial outcomes for many cancer patients and their families. Unsurprisingly, those who start off with the fewest resources are particularly vulnerable to the financial shock of cancer. What is not known, however, is how FWB changes over time for socioeconomically vulnerable individuals or how changes in FWB following a cancer diagnosis are related to clinical outcomes. Methods: We conducted a cross-sectional survey of stage I-III breast, colorectal, and prostate cancer survivors, age 21-64 years, diagnosed between 2008 and 2016, and identified from the population-based New Mexico Tumor Registry. Participants were asked to recall their financial situation at three time points: 1) in the year prior to cancer diagnosis, 2) in the year post-diagnosis, and 3) at the time of the survey. FWB was ascertained at all three of these time points using the validated Consumer Financial Protection Bureau Financial Well Being Scale (0-100; US Population Average=54) and mental and physical QoL were determined using PROMIS measures. Propensity score weighted multivariable linear regression was used to identify factors associated with changes in FWB over time and to estimate relationships between changes in FWB and mental and physical QoL. Results: A total of 394 cancer survivors completed the survey (response rate 33%; mean age 51y, mean time since diagnosis 6y, 42% Hispanic, 52% ≤ high school degree, 22% Medicaid-insured, 31% income &lt;$30,000, 33% rural). On average, FWB declined by 5 points (95% CI -6.17, -3.85) from the year before (mean 55, sd 14) to the year after (mean 50, sd 17) cancer diagnosis. Between the year post-diagnosis and the time of the survey (mean 53, sd 16), FWB scores increased by 3 points (95% CI 1.92, 3.98). However, cancer survivors with ≤high school degree had a significantly smaller improvement in their FWB than those with higher levels of education (estimate -2.37, 95% CI -4.44, -0.31). Importantly, each 1-point change in FWB from the year post diagnosis to the time of the survey was associated with higher mental (estimate 0.28; 95% CI 0.19-0.37) and physical (coefficient 0.19; 95% CI 0.13-0.25) QoL. Conclusion: Our data suggest that FWB declines in the year following a cancer diagnosis and rebounds thereafter. However, financial recovery is associated with important patient socioeconomic characteristics. Moreover, improvements in FWB between the year post diagnosis and the survey were associated with significant improvements in QoL. Targeted efforts to improve FWB in socioeconomically vulnerable cancer survivors, including those with lower levels of education, may be an effective strategy to reduce socioeconomic disparities in cancer outcomes that warrants further study.
Citation Format: Jean A. McDougall, Jessica Anderson, Shoshana Adler Jaffe, Charles L. Wiggins, Angela L. Meisner, Dolores D. Guest, Andrew L. Sussman, V. Shane Pankratz. Financial well-being and quality of life following a cancer diagnosis: A focus on socioeconomic disparities [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr A120.