Financial hardship and mental health among cancer survivors during the COVID-19 pandemic: An analysis of the US COVID-19 Household Impact Survey

Purpose: Our objective was to (1) identify associated characteristics of financial hardship (FH), and (2) evaluate associations of FH with mental health symptoms among cancer survivors during the COVID-19 pandemic. Methods: Using data from the nationally representative COVID-19 Impact Survey, we defined cancer survivors as those with a self-reported diagnosis of cancer (n = 854,7.6%). We defined FH using the following question: “Based on your current financial situation, how would you pay for an unexpected $400 expense?” Multivariable Poisson regression was used to estimate adjusted prevalence ratios (aPR) with 95% confidence intervals (95%CI) to identify associated characteristics of FH and associations of FH with mental health symptoms among cancer survivors overall and by age (18–59 years/60+ years). Results: Forty-one percent of cancer survivors reported FH, with 58% in 18–59 and 33% in 60+ year old respondents. Compared to cancer survivors aged 60+ years, those aged 30–44 (aPR:1.74,95% CI:1.35–2.24), and 45–59 years (aPR:1.60,95% CI:1.27–1.99) were more likely to report FH. Compared to non–Hispanic(NH)–White cancer survivors, NH–Black cancer survivors had a 56% higher prevalence of FH (aPR:1.56; 95% CI: 1.23–1.97). Among 60+ years aged cancer survivors, NH–Black (aPR:1.80; 95% CI: 1.32–2.45) and NH–Asian cancer survivors (aPR:10.70,95% CI:5.6–20.7) were more likely to experience FH compared to their NH–White counterparts. FH was associated with feeling anxious (aPR:1.51,95% CI:1.11–2.05), depressed (aPR:1.66,95% CI:1.25–2.22), and hopeless (aPR:1.84,95% CI:1.38–2.44). Conclusion: Minoritized communities, younger adults, and cancer survivors with low socioeconomic status had a higher burden of FH, which was associated with feelings of anxiety, depression, and hopelessness.