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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. 1Division of Cancer Services, Princess Alexandra Hospital, Brisbane, Queensland, Australia
  2. 2School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
  3. 3School of Nursing, UCSF, San Francisco, California, USA
  4. 4University of Pittsburgh, Pittsburgh, Pennsylvania, USA
  5. 5School of Nursing, University of Pittsburgh, Pittsburgh, PA, United States
  6. 6Flinders University, Adelaide, South Australia, Australia
  7. 7University of California Irvine, Irvine, California, USA
  8. 8Department of Pharmacy, University of California Irvine, Irvine, CA, United States
  9. 9National University of Singapore, Singapore
  10. 10QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
  11. 11School 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}


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

Statistics from


  • 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.

  • Patient consent for publication Obtained.

  • Ethics approval The study was approved by the Committee on Human Research at the University of California, San Francisco and by the Institutional Review Board at each of the study sites.

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

  • 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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