Thursday, August 22, 2024

Financial Problems, Mental Health, and Cancer

As I have said a few times in recent posts, I have been thinking a lot more lately about issues of survivorship -- not just what happens between diagnosis and treatment, but what happens after we're told we're "all better." 

That involves a lot of other issues, and they certainly include physical issues. We all deal with the physical issues that come with having cancer. And most of us also have to deal with the side effects of treatment -- short-term and long-term. (I'm dealing more and more with long-term side effects these days.)

But there are lots more non-physical side effects that we need to deal with, too. Emotional side effects are certainly prominent, and it's important to be aware of them and have a plan for dealing with them.

And then there are the financial side effects of having cancer. More and more advocates are using the term "financial toxicity" to describe these. Just as a clinical trial report will focus on "toxicity" (usually meaning the physical side effects of treatment), doctors and hospitals and pharma companies are being asked to pay attention to financial toxicity -- the side effects related to money.

This is an especially big issue in the United States, where for many people, our health insurance is tied to our jobs. Many other patients in the U.S. have some kind of government-sponsored health insurance, whether Medicare or a state- or federal-sponsored healthcare program. But even with health insurance, some treatments can cost a huge amount of money. CAR-T is a great treatment for many people, but also can cost close to a half million dollars. 

I can't say how much of a financial burden that cancer is for people outside the U.S. But even if treatment is paid for, there are so many other financial issues -- the cost of transportation to doctor appointments. Prescription medications for side effects. Loss of a job, and the cost of finding another one. Or loss of wages even if the job isn't lost. It all adds up.

This probably isn't news to any of you. Cancer is expensive.

But I also think it can be good to know that you're not the only one having problems. Blood-Cancer.org published a piece yesterday by Daniel Malito called "The Financial Cost of Cancer and How To Deal With It."Dan often writes about the funny things that have happened to him as a blood cancer patient. This article isn't so funny. He offers some advice about financial issues, such as disputing hospital bills. 

I thought it was a timely article, given how much I've been thinking about these kinds of issues lately, and given that the medical journal JCO Oncology Practice also published a piece a few days ago about financial toxicity.

The JCOOP article is called "Exploring the Relationship Among Financial Hardship, Anxiety, and Depression in Patients With Cancer: A Longitudinal Study."

In some ways, what the article says is not at all surprising -- basically, that there's a link between financial hardship and mental health in cancer patients, But I think it's important anyway, for a couple of reasons.

First, it's a longitudinal study -- it follows a number of patients for a long period of time (over a year), rather than doing a survey that measures what is happening at a particular moment (also important, but also much more common than a longitudinal study, which takes more effort to conduct). It's easy to say "Of course there is a link between financial issues and mental health." It's important to have a team of experts actually study it and write it up in a medical journal. It kind of makes it "official" that way.

And that's the second reason it is an important article -- it's in a medical journal aimed at clinical oncologists. Those are the doctors that see cancer patients every day. They are the ones that need to be aware of how a treatment will affect a patient's quality of life. They need to be aware of financial toxicity and its relationship to mental health. They need to know what survivorship means.

The JCOOP article is fairly easy to read, and I suggest you take a look if you're interested. But I'll mention one thing that I found most interesting -- financial hardship and mental health feed one another.

The researchers looked at data from 2,305 patients with cancer. They measured financial hardship, depression, and anxiety at 3, 6, 9, and 12 months after the study began. They found, for example, that having symptoms of depression at the beginning of the study and 6 months later, or having anxiety at 9 months, could predict that financial hardship was likely to happen later on. But it also predicted that having financial hardship at the 9 month point predicted that it was likely that symptoms of depression would come at the 12 month point.

In other words, financial problems can lead to mental health issues, but mental health issues can also lead to financial problems -- they are intimately related. 

In all, the researchers fund that about half of the patients in the study experienced financial hardship. As they say, "These findings underscore the need for a comprehensive approach in cancer care that concurrently addresses anxiety, depressive symptoms, and FH, recognizing their interconnected impact."

In other words, "Hey, doctors! Pay attention to patients' lives, even if their cancer seems to be getting better!"

And of course, survivorship also depends on us as patients. We need to be aware of the kinds of issues that we are likely to face -- physical, emotional, financial. And we need to make it a point to bring those issues up with our doctors, and ask if there is help available. Many cancer centers have survivorship programs, and many doctors don't know enough about them to make them effective.

So it's up to us as patients to make sure we are taken care of. 

Thanks for reading, and take care of yourselves.


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