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Original research
Distinct financial distress profiles in patients with breast cancer prior to and for 12 months following surgery
  1. Raymond Chan1,2,
  2. Bruce Cooper3,
  3. Steven Paul3,
  4. Yvette Conley4,5,
  5. Kord Kober3,
  6. Bogda Koczwara6,
  7. Alexandre Chan7,8,
  8. Chia Jie Tan9,
  9. Louisa Gordon10,
  10. Lebogang Thomy2,
  11. Jon Levine11 and
  12. Christine Miaskowski3
  1. 1 Division of Cancer Services, Princess Alexandra Hospital, Brisbane, Queensland, Australia
  2. 2 School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
  3. 3 School of Nursing, UCSF, San Francisco, California, USA
  4. 4 University of Pittsburgh, Pittsburgh, Pennsylvania, USA
  5. 5 School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
  6. 6 Flinders University, Adelaide, South Australia, Australia
  7. 7 University of California Irvine, Irvine, California, USA
  8. 8 Department of Pharmacy, University of California Irvine, Irvine, CA, USA
  9. 9 National University of Singapore, Singapore
  10. 10 QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
  11. 11 School of Medicine, UCSF, San Francisco, California, USA
  1. Correspondence to Dr Christine Miaskowski, School of Nursing, UCSF, San Francisco, CA 94143, USA; chris.miaskowski{at}nursing.ucsf.edu

Abstract

Background Study purposes were to identify subgroups of patients with breast cancer with distinct self-reported financial distress (FD) profiles and determine which demographic, clinical and symptom characteristics, as well as quality of life (QOL) outcomes were associated with subgroup membership.

Methods Patients (n=391) who were assessed for changes in FD a total of 10 times from prior to through 12 months after breast cancer surgery. Latent profile analysis was used to identify subgroups of patients with distinct FD profiles.

Results Three distinct FD profiles (ie, None (14.6%), Low (52.7%), High (32.7%)) were identified. Compared with None and/or Low subgroups, patients in the High subgroup were more likely to report a lower annual household income and performance status; had a higher body mass index, axillary lymph node dissection and more advanced stage disease; had a longer time from cancer diagnosis to surgery; and had received neoadjuvant or adjuvant chemotherapy. In addition, patients in the High subgroup reported higher fatigue, sleep disturbance, state/trait anxiety, depressive symptom scores, and lower attentional function and QOL scores.

Conclusion This study provides new insights on risk factors for and evidence of a higher symptom burden associated with FD. Findings from this study provide clinicians with information on how to identify high-risk patients and to recommend appropriate interventions for both symptom management and FD. Additional research on the mechanisms that underlie the relationships among FD and common physical and psychological symptoms may inform future interventions.

  • breast
  • symptoms and symptom management

Data availability statement

Data are available upon reasonable request. To access these data, individuals will need to submit a proposal which will be reviewed by the study investigators. If the proposal is accepted, individuals will need to complete a material transfer agreement with the University of California, San Francisco.

http://dx.doi.org/10.1136/bmjspcare-2020-002461

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    Data availability statement

    Data are available upon reasonable request. To access these data, individuals will need to submit a proposal which will be reviewed by the study investigators. If the proposal is accepted, individuals will need to complete a material transfer agreement with the University of California, San Francisco.

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    Footnotes

    • Contributors RC and CM conceived the study and wrote the initial draft of the manuscript; BC and SP performed the statistical analyses; all of the authors discussed the findings from this study, contributed to several revisions; and approved the final submission of the paper.

    • Funding The Oncology Nursing Foundation provided funding for this project. The original study was funded by grants from the National Cancer Institute (NCI, CA107091 and CA118658). CM is an American Cancer Society clinical research professor. This project was supported by NIH/NCRR UCSF-CTSI Grant Number UL1 RR024131. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the National Institutes of Health or the Oncology Nursing Foundation.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.