Financial hardship and mental health among cancer survivors during the COVID-19 pandemic: An analysis of the US COVID-19 Household Impact Survey

Jessica Y Islam; Kea Turner; Huda Saeb; Margaux Powell; Lorraine T Dean; Marlene Camacho-Rivera

doi:10.3389/fpubh.2022.946721

Financial hardship and mental health among cancer survivors during the COVID-19 pandemic: An analysis of the US COVID-19 Household Impact Survey

Front Public Health. 2022 Nov 22:10:946721. doi: 10.3389/fpubh.2022.946721. eCollection 2022.

Authors

Jessica Y Islam^{1

2}, Kea Turner^{2

3

4}, Huda Saeb⁵, Margaux Powell⁵, Lorraine T Dean^{6

7}, Marlene Camacho-Rivera⁸

Affiliations

¹ Cancer Epidemiology Program, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, United States.
² Department of Oncological Sciences, University of South Florida, Tampa, FL, United States.
³ Health Outcomes and Behavior Department, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, United States.
⁴ Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, United States.
⁵ Morehouse School of Medicine, Atlanta, GA, United States.
⁶ Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States.
⁷ Department of Oncology, School of Medicine, Johns Hopkins University, Baltimore, MD, United States.
⁸ Department of Community Health Sciences, SUNY Downstate Health Sciences University, Brooklyn, NY, United States.

Abstract

Purpose: Our objective was to (1) identify associated characteristics of financial hardship (FH), and (2) evaluate associations of FH with mental health symptoms among cancer survivors during the COVID-19 pandemic.

Methods: Using data from the nationally representative COVID-19 Impact Survey, we defined cancer survivors as those with a self-reported diagnosis of cancer (n = 854,7.6%). We defined FH using the following question: "Based on your current financial situation, how would you pay for an unexpected $400 expense?" Multivariable Poisson regression was used to estimate adjusted prevalence ratios (aPR) with 95% confidence intervals (95%CI) to identify associated characteristics of FH and associations of FH with mental health symptoms among cancer survivors overall and by age (18-59 years/60+ years).

Results: Forty-one percent of cancer survivors reported FH, with 58% in 18-59 and 33% in 60+ year old respondents. Compared to cancer survivors aged 60+ years, those aged 30-44 (aPR:1.74,95% CI:1.35-2.24), and 45-59 years (aPR:1.60,95% CI:1.27-1.99) were more likely to report FH. Compared to non-Hispanic(NH)-White cancer survivors, NH-Black cancer survivors had a 56% higher prevalence of FH (aPR:1.56; 95% CI: 1.23-1.97). Among 60+ years aged cancer survivors, NH-Black (aPR:1.80; 95% CI: 1.32-2.45) and NH-Asian cancer survivors (aPR:10.70,95% CI:5.6-20.7) were more likely to experience FH compared to their NH-White counterparts. FH was associated with feeling anxious (aPR:1.51,95% CI:1.11-2.05), depressed (aPR:1.66,95% CI:1.25-2.22), and hopeless (aPR:1.84,95% CI:1.38-2.44).

Conclusion: Minoritized communities, younger adults, and cancer survivors with low socioeconomic status had a higher burden of FH, which was associated with feelings of anxiety, depression, and hopelessness.

Keywords: COVID-19; SARS-CoV-2; anxiety; cancer survivors; depression; financial hardship; mental health; pandemic.

MeSH terms

COVID-19* / epidemiology
Cancer Survivors*
Humans
Low Socioeconomic Status
Mental Health
Middle Aged
Neoplasms* / epidemiology
Pandemics