Exploratory Factor Analysis of a Measure of Cost-Coping in Financially Burdened Cancer Patients and Survivors

Background: Many cancer patients and survivors must cope with high out-of-pocket expenses related to their illness. Though scholars have identified at least two distinct coping strategies, there is no validated instrument for measuring cost-coping in this population. This study advances empirical research on this topic by exploring the underlying factor structure of a formative measure of cost-coping using survey data from a U.S. sample of cancer patients and survivors.

Methods: An online survey was administered to a stratified, purposive sample of 510 cancer patients and survivors to better understand how cancer affected their finances. Respondents were stratified to approximate features of the U.S. population of cancer survivors. Within the survey questions, 33 items were consistent with cost-coping theory and past empirical research. Principal factors analysis was used to identify the underlying factor structure and reduce the number of items in the scale.

Results: Respondents were largely female (65%), ranging in age from 25 – over 75 years old (55% >55 y.o.), White (71%) African American (19%) and Hispanic (6%). All respondents were insured, and over half were covered by Medicare or Medicaid (54%). The most common cancer types were breast (29%), prostate (10%) and colorectal (8%). Most respondents were diagnosed over four years ago (44%).

Principal Factors Analysis was conducted using StataIC statistical computing software. The 33 items were determined to be factorable using Bartlett Test of Sphericity (p=0.00) and KMO Measure of Sampling Adequacy (KMO=0.929). Principal factors analysis revealed an underlying 3-factor structure in the 33 items related to cost-coping, accounting for 64%, 13% and 9% of the variance respectively. The three factor solution explained 85.7% of the total variance. To aid in interpretation of these three components, Oblimin rotation was performed and loadings for each item were analyzed to produce a 26-item, 3 factor measure of cost-coping.

Implications: These preliminary findings suggest that cost-coping should be further examined as a multidimensional construct with three possible factors. Though literature on this topic is sparse, scholars have identified at least two cost-coping strategies:  care-altering (i.e. postponing, forgoing or reducing treatment) and lifestyle-altering (i.e. cutting back on essential and non-essential expenses). This study aligns with those findings and proposes a third possible cost-coping strategy, self-advocacy, which can be measured in reports of how often one proactively anticipated or responded to unaffordable medical interventions.