Dyadic effects of financial toxicity and social support on the fear of cancer recurrence in breast cancer patients and caregivers: an actor–partner interdependence mediation model

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Abstract

Purpose

In this study, the actor–partner interdependence mediation model (APIMeM) was applied to breast cancer patients and their caregivers to assess the factors that affect the fear of cancer recurrence. In particular, the purpose of this study was to evaluate the mediating effect of social support on financial toxicity and the fear of cancer recurrence, providing an effective basis for developing plans to reduce the level of fear of cancer recurrence.

Methods

This study employed a cross-sectional design, and 405 dyads of breast cancer patients and their caregivers were enrolled. Financial toxicity, social support, and fear of cancer recurrence were assessed by computing comprehensive scores for financial toxicity based on patient-reported outcome measures, the Social Support Rating Scale, and the Fear of Cancer Recurrence Inventory Short Form, respectively. The data were analysed using SPSS 24.0 and AMOS 23.0.

Results

The results showed that the fear of cancer recurrence of breast cancer patients and their caregivers was significantly related to dyadic financial toxicity and social support. In addition, the financial toxicity of breast cancer patients and their caregivers had significant actor effects and partner effects on the fear of cancer recurrence through dyadic social support.

Conclusions

The financial toxicity of breast cancer patients and their caregivers could produce actor and partner effects on the fear of cancer recurrence through the mediation of social support, which provided empirical support for improving reducing the level of fear of cancer recurrence among patients and caregivers at the dyadic level.

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Most cited references 27

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The development of a financial toxicity patient-reported outcome in cancer: The COST measure.

Jonas de Souza, Bonnie J Yap, Fay Hlubocky … (2014)

Considering patients' experience is essential for optimal decision-making. However, despite increasing recognition of the impact of costs on oncology care, there is no patient-reported outcome measure (PROM) that specifically describes the financial distress experienced by patients.

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Assessing Mediation in Dyadic Data Using the Actor-Partner Interdependence Model

Thomas Ledermann, Siegfried Macho, David A Kenny (2011)

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Financial Burdens of Cancer Treatment: A Systematic Review of Risk Factors and Outcomes

Grace Smith, Maria A Lopez-Olivo, Pragati G. Advani … (2019)

Patients with cancer experience financial toxicity from the costs of treatment, as well as material and psychologic stress related to this burden. A synthesized understanding of predictors and outcomes of the financial burdens associated with cancer care is needed to underpin strategic responses in oncology care. This study systematically reviewed risk factors and outcomes associated with financial burdens related to cancer treatment. MEDLINE, Embase, PubMed, PsychINFO, and the Cochrane Library were searched from study inception through June 2018, and reference lists were scanned from studies of patient-level predictors and outcomes of financial burdens in US patients with cancer (aged ≥18 years). Two reviewers conducted screening, abstraction, and quality assessment. Variables associated with financial burdens were synthesized. When possible, pooled estimates of associations were calculated using random-effects models. A total of 74 observational studies of financial burdens in 598,751 patients with cancer were identified, among which 49% of patients reported material or psychologic financial burdens (95% CI, 41%−56%). Socioeconomic predictors of worse financial burdens with treatment were lack of health insurance, lower income, unemployment, and younger age at cancer diagnosis. Compared with patients with health insurance, those who were uninsured demonstrated twice the odds of financial burdens (pooled odds ratio [OR], 2.09; 95% CI, 1.33–3.30). Financial burdens were most severe early in cancer treatment, did not differ by disease site, and were associated with worse health-related quality of life (HRQoL) and nearly twice the odds of cancer medication nonadherence (pooled OR, 1.70; 95% CI, 1.13–2.56). Only a single study demonstrated an association with increased mortality. Studies assessing the comparative effectiveness of interventions to mitigate financial burdens in patients with cancer were lacking. Evidence showed that financial burdens are common, disproportionately impacting younger and socioeconomically disadvantaged patients with cancer, across disease sites, and are associated with worse treatment adherence and HRQoL. Available evidence helped identify vulnerable patients needing oncology provider engagement and response, but evidence is critically needed on the effectiveness of interventions designed to mitigate financial burden and impact.

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Author and article information

Contributors

Hui Ren: renhui2014@jlu.edu.cn

Journal

Journal ID (nlm-ta): BMC Nurs

Journal ID (iso-abbrev): BMC Nurs

Title: BMC Nursing

Publisher: BioMed Central (London )

ISSN (Electronic): 1472-6955

Publication date (Electronic): 5 June 2024

Publication date PMC-release: 5 June 2024

Publication date Collection: 2024

Volume: 23

Electronic Location Identifier: 378

Affiliations

[1 ]The First Hospital of Jilin University, ( https://ror.org/034haf133) Changchun, Jilin Province China

[2 ]Heping Hospital Affiliated to Changzhi Medical College, ( https://ror.org/0340wst14) Changzhi, Shanxi Province China

[3 ]China-Japan Union Hospital of Jilin University, ( https://ror.org/00js3aw79) Changchun, Jilin Province China

[4 ]Changchun Central Hospital, Changchun, Jilin Province China

Article

Publisher ID: 2046

DOI: 10.1186/s12912-024-02046-0

PMC ID: 11151716

PubMed ID: 38840268

SO-VID: 12034e9c-fb58-49c0-b74f-d22e69d0fe97

License:

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 23 January 2024

Date accepted : 27 May 2024

Funding

Funded by: Chinese Nursing Association

Award ID: No. ZI1KY20209

Custom metadata

ScienceOpen disciplines: Nursing

Keywords: breast cancer,fear of cancer recurrence,financial toxicity,social support,actor–partner interdependence mediation model

Data availability:

ScienceOpen disciplines: Nursing

Keywords: breast cancer, fear of cancer recurrence, financial toxicity, social support, actor–partner interdependence mediation model

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Dyadic effects of financial toxicity and social support on the fear of cancer recurrence in breast cancer patients and caregivers: an actor–partner interdependence mediation model

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Abstract

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Karger: Oncology

Most cited references 27

The development of a financial toxicity patient-reported outcome in cancer: The COST measure.

Assessing Mediation in Dyadic Data Using the Actor-Partner Interdependence Model

Financial Burdens of Cancer Treatment: A Systematic Review of Risk Factors and Outcomes

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