Financial Hardship and Quality of Life for Patients With Cancer

By Dustin Samples - January 9, 2023

We tend to think of the adverse effects of cancer as either mortality or medical morbidity, as reducing the occurrence of both are the primary goals of cancer treatment. Studies on quality-of-life (QOL) often focus on pain, mobility, psychosocial trauma, relapse, toxicity, and similar factors. One lesser studied­­­—but very real adverse effect of cancer—is financial hardship (FH). This can greatly affect QOL.

One late 2022 study published in Value in Health systematically reviewed the existing literature on comparisons between health related QOL (HRQOL) and financial toxicity using the Comprehensive Score for Financial Toxicity tool. Of 31 studies included in the analysis, “All but one…reported that higher financial toxicity was significantly associated with worse HRQOL. Ten HRQOL domains were correlated with financial toxicity, including physical health (r = 0.34-0.66), social health (r = 0.16-0.55), mental health (r = 0.21-0.54), and daily functioning (r = 0.23-0.52).”

More recently, Sarah Belcher, PhD, RN, OCN, and colleagues initiated a pilot study examining the relationship between FH and QOL in 78 patients with advanced cancer receiving outpatient palliative care. Dr. Belcher’s team sent questionnaires to gather descriptive statistics on FH, QOL dimensions, symptom burden, and sociodemographic and clinical characteristics.

At an average age of 56.6 years (SD, 12.2), the majority White (50%), female (56.4%) study group reported that 70% had either some or extreme difficulty paying for basic needs. Financial hardship had a significantly negative impact on “physical health (P = .008), pain (P = .003), and emotional well-being (P = .017) QOL dimensions,” according to Dr, Belcher.

QOL outcomes clearly have at least some correlations with FH. Dr. Belcher’s study concluded that larger, longitudinal studies are needed. Until further research is published, nurses should be aware of the burden of FH on their patients, and FH should remain a focal point in the treatment of the whole patient.


Comprehensive score for financial toxicity and health-related quality of life in patients with cancer and survivors: a systematic review and meta-analysis.

Financial hardship and quality of life among patients with advanced cancer receiving outpatient palliative care: a pilot study.