Relationships Among Financial Distress, Emotional Distress, and Overall Distress in Insured Patients With Cancer

  1. Copyright © 2016 by American Society of Clinical Oncology
  2. Relationships Among Financial Distress, Emotional Distress, and Overall Distress in Insured Patients With Cancer
  1. Corresponding author: Yu-Ning Wong, MD, MSCE, Fox Chase Cancer Center, Temple University Health System, 333 Cottman Ave, Philadelphia, PA 19111; e-mail:


Purpose: Recent studies have demonstrated increasing rates of financial toxicities and emotional distress related to cancer treatment. This study assessed and characterized the relationships among financial distress, emotional symptoms, and overall distress in patients with cancer.

Methods: A cross-sectional sample of patients with cancer who visited our outpatient medical oncology and psychiatry clinics completed a pen-and-paper survey. The survey assessed demographics; cost concerns; and financial, emotional, and overall distress.

Results: One hundred twenty insured patients completed the survey. Sixty-five percent reported clinically significant overall distress scores, with the same percentage reporting at least one emotional problem (worry, anxiety, depression, etc). Twenty-nine percent scored in the range of high to overwhelming financial distress. By using structural equation modeling, we found that financial distress was associated with overall distress. This association was both direct (accounting for 76% of the effect) and indirect (accounting for 24% of the effect) via mediation by emotional distress.

Conclusion: This cohort of patients with cancer reported significant levels of emotional distress, financial distress, and overall distress. These factors were interrelated, with both financial and emotional distress contributing to overall distress. Interventions targeted at alleviating financial distress may help to decrease levels of overall distress



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