Date of Degree

9-2019

Document Type

Dissertation

Degree Name

Ph.D.

Program

Social Welfare

Advisor

Daniel Gardner

Committee Members

Nancy Giunta

Alexis Kuerbis

Irwin Epstein

Keywords

Cancer, financial toxicity, financial hardship, stress, coping, oncology social work

Abstract

Financial hardship, a growing problem for cancer patients and survivors, is associated with increased pain and symptom burden, reduced quality of life and psychological wellbeing, poor treatment adherence, and early mortality. Nearly one in three cancer patients reports that cancer caused some financial stress or strain. Emerging research has begun to explore the coping strategies used by cancer-affected individuals to manage the direct and indirect costs associated with cancer and its treatment. This dissertation seeks to answer three research questions: (1) what are the measurable characteristics of different cost-coping strategies? (2) what behavioral, institutional, and social factors are associated with variations in coping? and (3) to what extent do these distinct coping strategies mediate and/or moderate the relationship between material financial stress and perceived financial strain?

To address these research questions, multivariate statistical methods were used to analyze existing survey data on the financial concerns from a stratified, random, national sample of insured cancer patients and survivors (N = 511). Exploratory factor analysis was used to identify the four underlying dimensions of problem-focused cost-coping and delineate working scales for each hypothesized coping strategy: care-altering, lifestyle-altering, self-advocacy and financial help-seeking. Stepwise logistic regression was used to model significant predictors of each cost-coping strategy. Lastly, to explore the possible effectiveness of each cost-coping strategy, linear regression-based mediation and moderation modeling using Hayes’ PROCESS analysis was used to measure the extent to which each strategy intervened in the relationship between material financial stress and the perceived financial strain.

Two strategies played meaningful intermediary roles: lifestyle-altering and self-advocacy. Lifestyle-altering, used more often by women and people of color, partially mediated the positive, linear relationship between stress and strain (B = 0.08, pB=-0.01, pFindings from this study contribute to the literature on financial stress and strain as social determinants of health by proposing a model of financial coping in cancer that may facilitate the development of interventions, programs and policies that improve financial wellbeing in people affected by cancer by supporting successful coping and targeting the delivery of material and psychosocial resources where they are needed most.

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