Associations Between Cancer-Related Financial Hardship, Pain, and Opioid Use

Cancer-related financial hardship, encompassing the high out-of-pocket treatment costs and associated distress, is associated with adverse treatment outcomes. However, its impact on clinical outcomes such as pain remains underexplored.

This secondary, retrospective cohort study examined associations between financial hardship and pain among patients with cancer initiating systemic therapy. Patient-reported pain was captured weekly over the first 6 months of treatment via remote symptom monitoring. Financial hardship was assessed at treatment initiation via the FACIT-COST instrument. Opioid use was abstracted from electronic medical records. Generalized linear models estimated associations between pain and financial hardship using relative risks (RR), predicted probabilities, and corresponding 95% CIs. Associations between financial hardship and opioid use were similarly modeled, stratified by pain severity.

Of 331 patients (median age 60 years; 28% Black; 40% stage IV), 48% reported financial hardship. Moderate/severe pain was reported by 25% and 24% at 3 and 6 months after treatment initiation, respectively. In adjusted models, patients reporting financial hardship had a 37% higher risk of moderate/severe pain over 6 months compared with those reporting no/minimal financial hardship (RR, 1.37 [95% CI, 1.04 to 1.80]). During cancer treatment, patients reporting financial hardship had higher probabilities of opioid use than those reporting no/minimal financial hardship, both among those with moderate/severe (55% [95% CI, 40 to 77] v 44% [95% CI, 30 to 63]) and no/mild pain (40 [95% CI, 30 to 53] v 30% [95% CI, 21 to 42]).

Financial hardship is associated with increased risk of pain and greater opioid use during cancer treatment. Integrating financial screening into clinical workflows may identify high-risk patients and inform interventions, such as financial navigation and tailored pain management, to mitigate the clinical consequences of financial hardship.