Oncology Nurses: Understanding Financial Hardship in Lung Cancer Care

Financial hardship is a challenge faced by many families in the wake of a lung cancer diagnosis, and it can have far-reaching consequences on physical and mental health, quality of life, and other health domains. A new study examined patient-caregiver dyads after receipt of a recent lung cancer diagnosis to highlight the impact of financial strain on quality of life and psychologic distress, as well as to underscore the critical role oncology nurses play in early identification and intervention of financial hardship. A team of researchers from the University of Hong Kong conducted the study and published their findings in Seminars in Oncology Nursing. The cross-sectional study evaluated 218 patient-caregiver dyads across a spectrum of financial hardship outcomes. Financial hardship outcomes that were analyzed included financial distress, material financial hardship, psychologic financial hardship, and behavioral financial hardship. Measurement instruments used to evaluate the data included the Personal Financial Wellbeing Scale and the Comprehensive Score for Financial Toxicity, among others. In addition, quality of life was evaluated by means of the 12-item Short Form Health Survey, and psychologic distress was evaluated using the National Comprehensive Cancer Network (NCCN) Distress Thermometer. According to the methodology, “dyadic associations” between financial hardship, quality of life, and overall distress were analyzed via Actor-Partner Interdependence Modeling. Average scores from the Personal Financial Wellbeing Scale between patients and caregivers were 4.63 and 5.13, respectively. Material financial hardship was reported by 10.1% of patients and 16.5% of caregivers, and 46.3% of patients and 81.7% of caregivers reported experiencing work disruptions, respectively. Furthermore, average scores from the Comprehensive Score for Financial Toxicity were 16.56 and 19.83 for patients and caregivers, respectively, and financial sacrifices were reported by 54.6% of patients and 61% of caregivers. The results revealed “significant correlations” across health outcomes between the two groups, including the domains of financial hardship outcomes, quality of life, psychologic distress, and work-related variables. Actor-Partner Interdependence Modeling also elucidated associations between health outcomes across dyads and showed that each person’s financial health was associated with “their own” quality of life and distress levels. However, “partner effects revealed that patients’ financial hardship was associated with caregivers’ distress.” In reflecting on the implications for oncology nursing practice, the investigators highlighted that “oncology nurses should incorporate early FH [financial hardship] screening into routine assessments for both patients and caregivers, recognizing the interconnected nature of their experiences.” They explained that dyad-focused interventions that addressed financial sacrifices, work disruptions, and psychologic burden could help mediate the impact of finances on both psychologic health and quality of life. Financial hardship “is prevalent among newly diagnosed lung cancer families and linked to poorer QoL [quality of life] and greater distress within and across dyad members,” the researchers concluded. “Early financial screening and dyad or family-centered interventions are essential to mitigate FH [financial hardship] and its psychosocial impact.”