Financial worry and psychological distress among cancer survivors in the United States, 2013-2018

Support Care Cancer. 2021 Sep;29(9):5523-5535. doi: 10.1007/s00520-021-06084-1. Epub 2021 Mar 16.


Background: A growing proportion of cancer survivors experience financial toxicity. However, the psychological burden of cancer costs and associated mental health outcomes require further investigation. We assessed prevalence and predictors of self-reported financial worry and mental health outcomes among cancer survivors.

Patients and methods: Data from the 2013-2018 National Health Interview Survey (NHIS) for adults reporting a cancer diagnosis were used. Multivariable ordinal logistic regressions defined adjusted odds ratios (AORs) of reporting financial worry by relevant sociodemographic variables, and sample weight-adjusted prevalence of financial worry was estimated. The association between financial worry and psychological distress, as defined by the six-item Kessler Psychological Distress Scale was also assessed.

Results: Among 13,361 survey participants (median age 67; 60.0% female), 9567 (71.6%) self-reported financial worry, including worries regarding costs of paying for children's college education (62.7%), maintaining one's standard of living (59.7%), and medical costs due to illness or accident (58.3%). Female sex, younger age, and Asian American race were associated with increased odds of financial worry (P < 0.05 for all). Of 13,218 participants with complete responses to K6 questions, 701 (5.3%) met the threshold for severe psychological distress. Participants endorsing financial worry were more likely to have psychological distress (6.6 vs. 1.2%, AOR 2.89, 95% CI 2.03-4.13, P< 0.001) with each additional worry conferring 23.9% increased likelihood of psychological distress.

Conclusions: A majority of cancer survivors reported financial worry, which was associated with greater odds of reporting psychological distress. Policies and guidelines are needed to identify and mitigate financial worries and psychologic distress among patients with cancer, with the goal of improving psychological well-being and overall cancer survivorship care.

Keywords: Cancer survivorship; Financial toxicity; Financial worry; Psycho-oncology; Survivorship.

MeSH terms

  • Adult
  • Aged
  • Anxiety / epidemiology
  • Cancer Survivors*
  • Child
  • Female
  • Humans
  • Male
  • Neoplasms*
  • Psychological Distress*
  • Stress, Psychological / epidemiology
  • Surveys and Questionnaires
  • Survivorship
  • United States / epidemiology