Financial burden and quality of life among thyroid cancer survivors

Background: Survivors of cancer in the United States are often financially encumbered by expenses and lost wages from cancer treatment. The majority of patients with thyroid cancer are diagnosed before age 65, when they are not eligible for Medicare. We hypothesized that financial distress would be common among thyroid cancer survivors and would be associated with poor health-related quality of life. Methods: A financial distress questionnaire and Patient-Reported Outcomes Measurement Information System (29-item) were completed online by 1,743 adult thyroid cancer survivors living in the United States. Multivariable modeling was used to identify variables which independently predicted poor health-related quality of life. The magnitude of predicted change was estimated by β coefficients and 95% confidence intervals. A β ≥3 was considered clinically significant; α was set at 0.01. Results: Financial difficulties were reported by 43% of thyroid cancer survivors and were associated with worse anxiety (β = 5.07; P < .01) and depression (β = 5.47; P < .01). Living in poverty was associated with worse anxiety (β = 4.14; P < .01) and depression (β = 4.35; P < .01). Lost productivity at work was associated with worse fatigue (β = 5.99; P < .01) and social functioning (β = –4.07; P < .01). Inability to change jobs was associated with worse fatigue (β = 3.08; P < .01), pain interference (β = 3.56; P < .01), and social functioning (β = –3.09; P < .01). Receiving disability benefits was associated with worse pain interference (β = 3.93; P < .01). Impaired ability to obtain a job was associated with worse social functioning (β = –3.02; P < .01). Reported unemployment rate was 12.3%. Conclusion: Financial distress and negative financial events were common among thyroid cancer survivors and were associated with poorer health-related quality of life across 5 Patient-Reported Outcomes Measurement Information System health domains.