Pain has detrimental effect on employment, financial outcomes among cancer survivors
Pain experienced by cancer survivors appeared associated with adverse employment and financial outcomes, according to study results published in Journal of Clinical Oncology.
Better evaluation of pain severity among cancer survivors and strategies to assist with employment and financial plans may enhance patient-centered care, researchers noted.
“There has been increased recognition of the importance of financial hardship among cancer survivors, which can result from the impacts of cancer and cancer treatment on employment, as well as out-of-pocket medical care and related costs experienced by individuals with cancer,” Michael T. Halpern, MD, PhD, MPH, medical officer in the health care assessment research branch of the Healthcare Delivery Research Program in the division of cancer control and population sciences at NCI, told Healio. “Many researchers have also highlighted patient-centered cancer care, including asking patients about symptoms they may be experiencing and providing access to care for these symptoms.”
Individuals with a history of cancer frequently report pain, which often is underdiagnosed and undertreated, Halpern added
Michael T. Halpern
“Many studies have shown that cancer pain can have substantial quality-of-life impact,” he said. “We were, therefore, interested in whether pain — particularly among long-time cancer survivors — was affecting their work and financial status, and whether there was a dose-response relationship between level of pain and economic impacts.”
Halpern and colleagues assessed the role of pain levels on employment and financial outcomes among 1,213 adults diagnosed with cancer and included in the 2016-2017 Medical Expenditure Panel Survey Experiences with Cancer Survivorship Supplement.
Researchers used multivariable logistic regression analyses to assess the association of pain levels with self-reported employment and financial outcomes.
According to study results, 43.3% of cancer survivors reported no pain, 29.2% reported mild pain, 17.9% reported moderate pain and 9.6% reported severe pain.
Survivors who reported any type of pain had a significantly higher likelihood than those who reported no pain of adverse employment outcomes, including early retirement (87.4% vs. 12.6%; P < .0001) and feeling less productive at work (69.4% vs. 30.6%;P < .0001). A greater percentage of those who experienced pain also reported staying at a job because of concerns about losing health insurance (59.8% vs. 40.2%).
Results of multivariable logistic regression analyses adjusted for sex, race or ethnicity, and disease and treatment factors showed significant associations of any pain with all these outcomes.
In addition, survivors who reported any pain appeared more likely to experience adverse financial outcomes, such as borrowing money or going into debt (75% vs. 25%; P = .0003), inability to cover medical costs (68.1% vs. 31.9%; P = .0003) and worrying about paying medical bills (65.8% vs. 34.2%; P = .0002).
Researchers also observed dose-response relationships for both employment and financial outcomes, with greater levels of pain associated with worse outcomes.
A couple of the findings surprised researchers, Halpern told Healio.
“First, we were surprised by how many individuals were experiencing substantial pain,” he said. “Second, we were surprised by the strength of the relationship between pain level and study outcomes. The odds of individuals with severe pain retiring early were 15-fold greater than those of individuals with no pain, and the odds of those with severe pain delaying medical care or necessary prescription medications were fivefold greater than [for] those with no pain.”
Additional research is underway examining the association of workplace issues experienced by patients with cancer and the likelihood of adverse financial outcomes.
“We are also interested in addressing the issues we described in this paper and hope to explore whether financial counselors or financial navigators can assist individuals with cancer, particularly those experiencing pain or other symptoms, and help decrease long-term employment impacts and financial hardship,” Halpern said.
Discussions with patients about the financial impacts of cancer and its treatment are critical, Halpern told Healio.
“This includes out-of-pocket treatment costs, but also potential job impacts and other financial effects,” he said. “We hope this study will encourage oncology health care professionals to initiate these financial conversations, as well as encourage patients to discuss pain and other symptoms they may experience. Patients are often reluctant to discuss pain and, as our study showed, pain can have substantial nonclinical impacts years after cancer treatment.”
For more information:
Michael T. Halpern, MD, PhD, MPH, can be reached at National Cancer Institute, 9609 Medical Center Drive, Room 3E342, Bethesda, MD 20892; email: michael.halpern@nih.gov.
Source: Healio