Private Insurance and Changing Employment are Risk Factors for Financial Distress


Patients with gynecologic cancer are at higher risk for financial distress if they are enrolled in private insurance, are young in age, or are undergoing an employment change.

Nearly 1 out of 2 patients with gynecologic cancer reported some degree of financial distress or financial toxicity, according to a recent study, published in the International Journal of Gynecologic Cancer. Oncology Nursing News spoke to corresponding author, Kate Esselen, MD, Department of Obstetrics
and Gynecology, Beth Israel Deaconess Medical Center, about the results of the study and which factors were associated with higher levels of financial toxicity.

The data showed that nearly half of patients with gynecologic cancer experienced some degree of financial distress and that patients with severe financial toxicity were significantly more likely to engage in behavioral cost-coping by medication non-compliance (adjusted risk ratio, 4.6; 95% CI, 1.2-18.1). Young age, unemployment, or having private insurance instead of public or federal insurance, resulted in a higher likelihood of financial distress for the patients. The data also demonstrated that changes in employment such as moving from full time to part time put patients at risk, but that being retired was protective, since patients were less dependent on their income.

“Certainly these are things that if you are hearing from your patients–that their insurance deductibles are high or that they are having to change their job and their employment–should be sort of cues to their provider to say, ‘Hey, how is everything? How are you feeling about your care? Are you feeling overwhelmed in any way related to the financial burden of it, or how it is impacting your family?’” Esselen said. “And [find] ways to open the conversation. Because when we have asked patients, they do want to talk about it, they just are not sure how.”


Esselen KMck, Gompers A, Hacker MR, et al. Evaluating meaningful levels of financial toxicity in gynecological cancers. Int J Gynecol Cancer. 2021; 31:801-806. doi:10.1136/ ijgc-2021-002701.

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