The Impact of Financial Toxicity on Psychological Well-Being, Coping Self-Efficacy, and Cost-Coping Behaviors in Young Adults with Cancer

Publication Date


Journal Title

J Adolesc Young Adult Oncol


© Copyright 2019, Mary Ann Liebert, Inc., publishers 2019. Purpose: The increase in cost-sharing between patients and payers has resulted in financial toxicity in cancer patients, particularly among young adult (YA) patients and survivors (age). This study explored financial toxicity and its impact on psychological well-being, self-efficacy for coping with cancer, and cost-coping behaviors among a sample of YA cancer patients and survivors. Methods: One hundred forty YAs completed an anonymous online survey. The Comprehensive Score for Financial Toxicity measured financial toxicity and the Cancer Behavior Inventory-Brief measured coping self-efficacy. The Patient Health Questionnaire-4 and items from the Impact of Cancer-Young Adult and the Cancer Needs Questionnaire-Young People assessed psychological well-being. A single item assessed cost-coping behaviors (i.e., skipping or delaying treatment because of its cost). Analyses included Pearson and Spearman correlation matrices and multivariate regression modeling. Results: Worse financial toxicity was associated with lower insurance satisfaction (r = 0.52, p < 0.001), higher levels of depressive and anxiety symptoms (r = -0.42, p < 0.001), greater worry (p < 0.001), and lower self-efficacy in coping with cancer (i.e., maintaining independence and a positive attitude, r = 0.41, p < 0.001; coping and stress management, r = 0.43, p < 0.001; and managing negative effect, r = 0.20, p = 0.02). In multivariate modeling, financial toxicity related to skipping or delaying treatment and greater anxiety and depression symptomology, controlling for relevant covariates. Conclusion: The findings suggest financial toxicity negatively impacts many facets of the YA cancer experience. There is a need to address the cost of cancer care with patients to ensure they are informed about the financial implications of treatment decisions and to support financial planning as needed.

Volume Number


Issue Number



236 - 242

Document Type





School of Medicine

Primary Department

General Internal Medicine





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