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Financial Impact of Colorectal Cancer and Its Consequences: Associations Between Cancer-Related Financial Stress and Strain and Health-Related Quality of Life

Sharp, Linda, Ph.D.1; O’Leary, Eamonn, M.Sc.2; O’Ceilleachair, Alan, M.Econ.Sc.2; Skally, Mairead, M.Sc.3; Hanly, Paul, Ph.D.4

Diseases of the Colon & Rectum: January 2018 - Volume 61 - Issue 1 - p 27–35
doi: 10.1097/DCR.0000000000000923
Original Contributions: Colorectal Cancer
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BACKGROUND: The financial impact and consequences of cancer on the lives of survivors remain poorly understood. This is especially true for colorectal cancer.

OBJECTIVE: We investigated objective cancer-related financial stress, subjective cancer-related financial strain, and their association with health-related quality of life in colorectal cancer survivors.

DESIGN: This was a cross-sectional postal survey.

SETTINGS: The study was conducted in Ireland, which has a mixed public–private healthcare system.

PATIENTS: Colorectal cancer survivors, diagnosed 6 to 37 months prior, were identified from the population-based National Cancer Registry.

MAIN OUTCOME MEASURES: Cancer-related financial stress was assessed as impact of cancer on household ability to make ends meet and cancer-related financial strain by feelings about household financial situation since cancer diagnosis. Health-related quality of life was based on European Organisation for Research and Treatment of Cancer QLQ-C30 global health status. Logistic regression was used to identify associations between financial stress and strain and low health-related quality of life (lowest quartile, score ≤50).

RESULTS: A total of 493 survivors participated. Overall, 41% reported cancer-related financial stress and 39% cancer-related financial strain; 32% reported both financial stress and financial strain. After adjustment for sociodemographic and clinical variables, the odds of low health-related quality of life were significantly higher in those who reported cancer-related financial stress postdiagnosis compared with those who reported no change in financial stress postcancer (OR = 2.54 (95% CI, 1.62–3.99)). The odds of low health-related quality of life were also significantly higher in those with worse financial strain postdiagnosis (OR =1.73 (95% CI, 1.09–2.72)). The OR for those with both cancer-related financial stress and financial strain was 2.59 (95% CI, 1.59–4.22).

LIMITATIONS: Survey responders were younger, on average, than nonresponders. Responders and nonresponders may have differed in cancer-related financial stress and strain or health-related quality of life.

CONCLUSIONS: Four in 10 colorectal cancer survivors reported an adverse financial impact of cancer. Cancer-related financial stress and strain were significantly associated with low health-related quality of life. To inform support strategies, additional research is needed to better understand how both objective and subjective financial distress influence survivors’ health-related quality of life. See Video Abstract

1 Institute of Health & Society, Newcastle University, Newcastle upon Tyne, United Kingdom

2 National Cancer Registry Ireland, Cork, Ireland

3 Beaumont Hospital, Dublin, Ireland

4 National College Ireland, Dublin, Ireland

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML and PDF versions of this article on the journal’s Web site (

Funding/Support: This study was funded by a grant from the Health Research Board (SA/2004/1).

Financial Disclosure: None reported.

Correspondence: Linda Sharp, Ph.D., Institute of Health & Society, Newcastle University, Baddiley Clark Building, Richardson Road, Newcastle-upon-Tyne, United Kingdom. E-mail:

© 2018 The American Society of Colon and Rectal Surgeons