Factors contributing to economic burden in lung cancer caregivers

Purpose: A substantial body of literature has described the impact of caregiving on the health and well-being of the family caregivers. Researchers have documented the physical, emotional, personal and financial costs of caregiving among those caring for elders with advanced chronic diseases. However, little attention has been paid to understanding the economic impact incurred by persons caring for someone with lung cancer. Lung cancer is the leading cause of cancer mortality in the US. Patients with lung cancer are diagnosed later and die earlier than other forms of cancer, thus relaying heavily on the family members for care. Moreover, the often cost prohibitive treatment options associated with lung cancer may lead to economic burden in the family caregiver. The purpose of this study is to describe economic outcomes reported by caregivers for persons with lung cancer, by examining the role stressors such as barriers to care and patient symptoms may have in explaining the path to economic burden.

Methods: The sample was drawn from a statewide survey of lung cancer caregivers in the state of Wisconsin. The data reported here include adult children and spouses, who returned the mailed survey (N=154). Results of this study were obtained using structural equation modeling, comprised of both factor and path analysis. The outcome of interest, economic burden, was derived through factor analysis using financial burden items from the Covinsky family impact survey (Covinsky, 1994). Following a stress process model, this study included exogenous contextual variables such as age, gender, education and income as well as two stressor indicators: number of patient physical and mental symptoms and barriers to care.

Results: Factor analysis was used to isolate the main outcome variable, economic burden. Factor loadings pointed to four variables (caregiver had to move, put off medical treatment, put off education, went into debt) representing the latent variable, economic burden. Results of the structural equation model path analysis showed a significant indirect path between age and economic distress, through patient symptoms (p = .009), indicating that young caregivers providing care for patient with more symptoms had the most economic burden. Direct effects between age and economic burden were not significant, supporting the clear role patient symptoms play in the path to economic burden. Barriers to care, was not significantly associated with economic burden. Several direct effects between exogenous variables and economic burden show caregivers with less education (p=.02), who had children in the home (p=.01) are more adversely affected by caregiving.

Implications: Findings from this study suggest that caregiver age and patient symptoms are associated with higher levels of economic burden among family caregivers to persons with lung cancer. Given the limited treatments for lung cancer, understanding how patient symptoms may lead to economic burden in cargivers is an important implication for physicians and other health care providers. Additional implications for assessment and intervention to enhance social service provision for family caregivers will be highlighted.