Understanding Financial Hardship After Chronic Illness

One of the most devastating causes of depression and anxiety that I have seen in clinical practice is financial hardship. Financial hardship is when someone does not have enough money to afford housing, food, medical care, and other living costs. As I work primarily with people that have cancer or chronic medical conditions such as rheumatoid arthritis, most of this financial hardship is triggered by the effects of these illnesses. I often felt powerless to help these clients. So I channeled my energy into trying to understand financial hardship after illness, primarily cancer.

In 2020, I developed a model to help understand what leads to financial hardship after cancer. A model, in this context, is an abstract way of thinking about the human experience. This model can also apply to other medical conditions. The big distinction between my model and other models is that my team and I separated the causes of financial hardship from the actual financial impacts. We defined the causes as the high costs of medical care and difficulty working due to cancer or cancer treatment.

Even for people with good health insurance, the costs of cancer care can be high.

Some treatments are not covered by insurance. Some insurance only covers part of the costs. For people with cancer who are still working, treatments and side effects make it challenging to continue to work. If the person does not have enough paid sick leave or reasonable accommodations at work, they can lose income and have trouble paying for care and living costs.

Source: Alan Cleaver/Pixabay

Our model also delineates the dimensions of financial hardship. People engage in a variety of financial coping behaviors to afford cancer care and living costs. These include taking out loans, selling off property, and draining savings. When people with cancer are unable to cope with the costs of care and employment changes, they experience financial consequences such as bills going to collections.

However, there is a psychological dimension to financial hardship.

People can experience financial anxiety when they worry about affording their care and basic needs. They can experience depression triggered by financial hardship. It’s important to fully assess all dimensions of financial hardship. For example, if I only asked about three or four coping behaviors in my research study, I would miss a lot of the financial hardship experienced by people with cancer.

Financial hardship does not occur in a vacuum. The community in which a person lives can affect whether they experience financial hardship or not. Our model includes social support, as friends and family can provide money, food, and other resources that lessen the financial impact of cancer (or other chronic illnesses).

If a person has other medical conditions, this can make it harder for them to continue to work or add more medical costs. For example, if someone had migraines before cancer, they would have to pay for both the migraine medications and the cancer treatments. Both migraines and cancer treatments could lead to missed work.

A person’s resources before cancer diagnosis can also determine whether someone experiences financial hardship. Someone with a large amount of savings could weather cancer treatment better than someone with no savings. The place someone lives can affect a person’s experience of financial hardship through higher costs of rent and food.

The first step to addressing a problem is understanding it. With financial hardship in cancer, this means distinguishing causes (healthcare costs, difficulty working) from the dimensions of financial hardship (coping, consequences, anxiety). It also means understanding the context in which patients live. The next step is using this understanding to find solutions to the problem. But I’ll save those for another blog post.