Caring for Spouse With Cancer Linked to Ongoing Financial Instability

People who provide care for spouses with cancer — particularly those from low-income households — are more likely to experience a sustained decline in financial stability compared with caregivers with spouses with other conditions, according to a longitudinal cohort study.

Among caregivers younger than 65 with an annual household income below the median of $75,000, those with spouses with cancer were more likely to report decreased income (13.4 percentage points; P<0.10), increased household debt (14.5 percentage points; P<0.10), and to have stopped work (18.8 percentage points; P<0.05) compared with those with spouses with other illnesses, reported Cathy J. Bradley, PhD, MPA, of the University of Colorado Comprehensive Cancer Center in Aurora, and colleagues.

Of the 103 cancer caregivers included in this study, 35% reported that they had stopped working, and 30.1% saw their household debt increase, while these rates among the 515 caregivers of spouses with other conditions were 26.4% and 27.8%, respectively, the authors noted in the Journal of Clinical Oncology.

“This highlights the enormous and long-term financial impact of caregiving, regardless of condition,” Bradley and team observed. “We note that these differences were persistent and that caregivers did not return to their precaregiving financial situations, which potentially sets them up for long-term financial strain.”

Of note, 46.3% of cancer caregivers in low-income households had to stop working compared with 27.5% of caregivers in higher-income households, regardless of whether they were caring for spouses with cancer or other conditions. In addition, those in low-income households were more likely to report an increase in debt (40.8% vs 26.2%) and a decrease in income (64.5% vs 51.1%) compared with those in a higher-income household.

However, cancer caregivers in households above the median annual income of $75,000 experienced slightly fewer adverse financial outcomes relative to noncancer caregivers in similar households.

About 6 million people are caregivers to people with cancer, Bradley and colleagues said, with many remaining employed to support their household and to have access to health insurance.

While all caregivers experience a decline in financial stability, “caregivers of a spouse with cancer appear to suffer greater consequences that are sustained over time,” wrote Bradley and colleagues. Considering that lower-income households appear to experience a significantly greater degree of financial stress related to cancer care, “policies such as paid sick leave and family leave are needed for this strained and important population who have financial and employment responsibilities in addition to caregiving,” they added.

The authors also looked at the effects of caregiving on mental health, noting that while mental health declines were observed for all caregivers, those in low-income households were more likely to report a new mental health condition.

“Although these differences were not generally statistically significant, they are nonetheless important as they demonstrate mental health consequences of caregiving, especially for low-income households with few supports,” Bradley and team wrote. “A feeling of loneliness highlights the isolation felt by these caregivers.”

For this study, the authors used data from the Health and Retirement Study from 2002 through 2020.

A majority of cancer caregivers were women (59.2%), ages 55 and older (69.0%), non-Hispanic white (66.0%), and had health insurance through an employer (61.2%). About 44% lived in the southern region of the U.S., and nearly 17% reported their health status as poor or fair. Around a quarter had a college degree, and 56% had an annual household income above $75,000. Characteristics were similar in the control group.

Bradley and colleagues used logistic regression to evaluate the decrease in household income, increase in household debt, discontinuation of work, and new report of a mental health condition over a 4-year period, adjusting for socioeconomic and demographic characteristics, as well as health insurance status.

They noted that the absence of paid sick leave and health insurance outside of employers is very specific to the U.S., which limits the generalizability of the results to other countries.