Associations of Financial Hardship and Health Status, Social Functioning, and Mental Health Among Cancer Survivors in the United States: Findings From a Nationally Representative Study

PURPOSE Financial hardship is common among cancer survivors and has been associated with worse physical and mental health in selected subpopulations. We comprehensively examined associations of financial hardship with multiple measures of health status, social functioning, and mental health in a large, nationally representative sample of cancer survivors. MATERIALS AND METHODS We identified adults with a cancer history (18-64 years: n = 3,157 and ≥65 years: n = 5,991) from the 2019 to 2021 National Health Interview Survey. Associations of financial hardship and health status, social functioning (eg, difficulty doing errands alone), and mental health (eg, feeling worried, nervous, or anxious) were evaluated with separate multivariable logistic regressions stratified by age group (18-64 and ≥65 years) to reflect differences in employment, health insurance coverage, and underlying health, and adjusted percentages were calculated. RESULTS Cancer survivors with financial hardship were more likely to report fair/poor health (18-64 years: 34.7% v 23.2% and ≥65 years: 40.7% v 27.3%), social functioning limitations (18-64 years: 10.5% v 5.3% and ≥65 years: 18.1% v 11.1%), and work limitations (18-64 years: 36.0% v 26.2% and ≥65 years: 47.3% v 33.6%) than their counterparts without financial hardship in adjusted analyses (all P < .001). Survivors with financial hardship were also more likely to report frequent anxiety (18-64 years: 47.2% v 27.8% and ≥65 years: 36.2% v 16.3%) and depression (18-64 years: 21.7% v 10.8% and ≥65 years: 19.4% v 7.3%) than survivors without hardship (all P < .001). CONCLUSION In this large nationally representative sample, cancer survivors with financial hardship were more likely to report poorer health, social functioning limitations, and worse mental health across multiple measures than their counterparts without hardship. Interventions to screen and connect survivors with relevant services are warranted.