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Objectives: Disparities in employment and the sequelae of financial toxicity are on the rise and as high as 22% among gynecologic oncology patients. Despite this effort, distress related to unemployment remains unknown. We aimed to study the associations between employment, insurance status, and distress among gynecologic oncology patients. Secondary objectives were to study the impact of being unemployed and underinsured on different problem areas of distress. Methods: This is a single institution, cross sectional analysis of gynecologic oncology patients who were screened with the National Comprehensive Cancer Network distress thermometer and problem list (DT/PL) at their outpatient appointment between 6/2017-9/2017. Primary outcome was self-reported high distress (DT score ≥5). Employment status included employed, unemployed, homemaker, and retired. Underinsured was defined as self-pay or having Medicaid. The distress PL included 5 categories-practical, family, emotional, physical, and other. Logistic regression was used to assess whether unemployment and being underinsured predicted high distress, adjusting for age, race, relationship status, body mass index, and cancer stage. Subgroup analysis of 456 patients with DT score >0 was performed to assess associations between distress problem type and employment/insurance status using chi-square tests. Results: Among 885 women screened for distress, 101(12%) were unemployed, and 35 (6%) underinsured. Over half (51.5%) self-reported any distress (DT score >0), and 191 (21.6%) indicated high distress. Unemployed patients were 3.5 times more likely to endorse high distress than their employed counterparts [42.6% vs. 16.9%, adjusted odds ratio (aOR) = 3.5, 95% confidence interval (CI) 2.2 - 5.7, p Download : Download high-res image (143KB) Download : Download full-size image Conclusions: Distress among gynecologic oncology patients is disproportionately higher among those who are unemployed or underinsured. This elevated distress appears to extend beyond financial toxicity and stems from different problem areas. Future studies should investigate collaborative interventions between oncology providers, social workers and psychologists that mitigate the distinct problems of low socioeconomic patients in order to improve outcomes in distress and overall cancer care. |
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