Abstract
Background and Objectives: Financial toxicity significantly impacts many patients, especially cancer survivors. We evaluated the association of unemployment as a major contributor to financial toxicity with patient-reported outcomes (PROs) assessing multiple illness experience domains in a primary CNS tumor (PCNST) cohort.
Methods: Patient and disease characteristics and PROs measuring symptom burden, interference, psychologic distress, functional impairment, and health-related quality of life (HRQOL) from participants enrolled an IRB-approved observational study at the US National Institutes of Health’s Neuro-Oncology Branch were collected between 9/2016-12/2019. Descriptive statistics, tests of association, and comparison of group means were used to describe and evaluate PROs.
Results: Of the 277 participants diagnosed with a PCNST, 57% were male and 43% were female. Participants reported their race as White, non-Hispanic (78%); White, Hispanic/Latino (9%); Asian (7%); Black (4%); Native Hawaiian/Pacific Islander (1%); other (2%) with 8% missing. The median age of the overall cohort was 45 years (range 18-74). Hispanic participants in the overall sample were 2.3 times more likely, and in the brain tumor group 3.2 times more likely, to report unemployment (p=.043, OR=2.3, 95% CI [1.0, 5.4] and p=.008, OR=3.2, 95% CI [1.3, 7.9], respectively). The 77 (28%) individuals unemployed due to tumor reported more functional impairment with walking, washing, dressing, performing usual activities, and reduced HRQOL (p<.001). More unemployed participants in the total sample reported moderate-to-severe depressive symptoms (25%) than those employed (8%) (X2(1)=13.9, p<.001, OR=3.7, 95% CI [1.8, 7.8]) and more moderate-to-severe anxiety symptoms (30%) than those employed (15%) (X2(1)=7.8, p=.005, OR=2.4, 95% CI [1.3, 4.5]). Unemployed brain tumor participants reported on average 3 more symptoms as moderate-to-severe compared to those employed (t(83)=-4.0, 95% CI 
difference [-5, -2], p<.001, Hedge’s g=.70).
Discussion: Being unemployed due to a PCNST strongly correlated with high symptom burden, functional impairment, psychological distress and reduced HRQOL which may be impediments to returning to work that warrant intervention. Lack of employer-based health insurance and reduced earnings are financial sequelae of unemployment superimposed on the physical, social, and cognitive effects of living with a PCNST. Innovations to screen for and address financial toxicity and its contributing factors are needed.
- Received June 22, 2022.
- Accepted in final form January 6, 2023.
- Written work prepared by employees of the Federal Government as part of their official duties is, under the U.S. Copyright Act, a “work of the United States Government” for which copyright protection under Title 17 of the United States Code is not available. As such, copyright does not extend to the contributions of employees of the Federal Government.
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