Financial distress in couples coping with metastatic breast cancer: cross sectional associations with sleep and caregiver health-related quality of life
Introduction
Risk factors and consequences of financial distress are increasingly acknowledged in oncology settings; however, the specific impact on the patient-caregiver dyad’s sleep and the spousal caregiver’s own health is yet to be fully examined. To increase the evidence based on associations of financial distress in couples coping with metastatic breast cancer, we examined specific associations of financial distress with sleep, psychological well-being and health-related quality of life for their caregivers, who are historically at greater risk for their own chronic health conditions.
Methods
Women diagnosed with Stage III or IV metastatic breast cancer in the past 12 months and their romantic partner (cohabitating >6mo) completed online assessments at one time point to evaluate financial distress (COST, ENRiCH), workplace activity interference (WPAI), sleep (ISI, PSQI for caregivers only), depression (CES-D), anxiety (GAD-7), and health-related quality of life (SF-12, physical component scores). Caregiver comorbid health conditions, BMI, smoking, and alcohol use were also reported. Cross-sectional associations were examined with Pearson partial correlations and linear regression models. Group differences were examined with paired sample t-tests.
Results
In the 100 dyad sample (n=200), (52% female, two same sex couples, Stage IV disease (53%), mean age= 50.2 years, 65.0% non-Hispanic White, 73.1% college educated, 72.6%≥$75,000 income), both patients (M=3.6, SD=2.4) and caregivers (M=3.2, SD=2.2) endorsed financial distress on the ENRiCH, where scores >2.1 are above the global mean. Regarding insomnia, patients (M=10.0, SD=6.0) reported more insomnia than caregivers (M=8.7, SD= 6.2), (ISI: t=1.36, p>.05) with 24% of patients endorsing moderate or severe symptoms. Greater financial distress was associated with greater sleep disturbance for both patients (ENRiCH and ISI: r=.33,p<.01) and caregivers (ENRiCH and ISI:r=.30,p<.01, ENRiCH and PSQItot: r=.38,p<.01) controlling for income. Greater financial distress was also associated with greater psychological distress for both members of the couple. For spousal caregivers, financial distress was additionally associated with poorer health-related quality of life.
Conclusion
Results highlight associations of financial distress and poorer sleep in the context of the patient-caregiver dyad for those coping with metastatic breast cancer. We further observe that for the spousal caregiver, financial distress is associated with poorer health-related quality of life. These findings highlight the value of future research assessing both patient and caregiver sleep as one component of the sequelae of financial distress. Future research across multiple samples and with longitudinal design will be essential to extend these findings.