Abstract: Examination of Longitudinal Interdependence between Financial Toxicity and Depressive Symptoms In Black Women with Breast Cancer (Society for Social Work and Research 31st Annual Conference)

Schedule:

Friday, January 22, 2027

Union Station 20 (Hilton San Francisco Union Square)

* noted as presenting author

Tess Thompson, PhD, Assistant Professor, University of North Carolina at Chapel Hill, NC

Thomas Rodebaugh, PhD, Associate Professor, Washington University in Saint Louis, St. Louis, MO

Demeisha Carlton-Brown, MSW, Doctoral Student, University of North Carolina at Chapel Hill

Julie Margenthaler, MD, Professor, Washington University in Saint Louis, MO

Marjory Charlot, MD, Associate Professor, University of North Carolina at Chapel Hill, NC

Melissa Troester, PhD, Professor, University of North Carolina at Chapel Hill, NC

Bridgette Thom, PhD, Assistant Professor, University of North Carolina at Chapel Hill, NC

Background and Purpose: Financial toxicity, or the negative economic effect of cancer treatment, has been cross-sectionally associated with lower quality of life and poorer psychosocial outcomes in patients with breast cancer. However, few studies have examined financial toxicity longitudinally or in Black women with cancer in particular.

Methods: Black women with non-metastatic breast cancer were enrolled in this study within two months of diagnosis. Participants responded to telephone surveys at T1 (enrollment), T2 (two months post-enrollment), T3 (four months post-enrollment) and T4 (18 months post-enrollment) and completed the COmprehensive Score for Financial Toxicity (COST) measure and the Center for Epidemiologic Studies Depression (CES-D) scale at each survey. A random-intercept cross-lagged panel model in Mplus examined the relationship between financial toxicity and depressive symptoms overall and over time. We hypothesized that the intercepts of financial toxicity and depressive symptoms would be negatively correlated (i.e., that an overall tendency towards better financial status would be negatively associated with an overall tendency towards greater depressive symptoms). We further hypothesized that financial toxicity and depressive symptoms would predict each other over time (i.e., that measures of each construct at one timepoint would be associated with values on the other construct at the next timepoint).

Results: Between January 2021 and May 2023, 107 women with breast cancer enrolled. Most (77%) reported at least some college education, 52% had private insurance, and 60% reported an annual household income below $40,000. Mean age was 58.5 (SD = 11.2); 83% had early-stage breast cancer (Stages 0-2A). Mean COST score was 24.1 (SD = 10.0) at baseline, and mean baseline CES-D score was 15.0 (SD = 10.9). In support of our first hypothesis, the intercepts for depressive symptoms and financial toxicity were highly correlated (r = –.63, p <.001), indicating a strong association between an overall tendency towards depression and financial toxicity across timepoints. There was an additional momentary correlation at 18 months (over and above the general correlation) of r = –.43 (p = .022), indicating an even stronger association between financial toxicity and depressive symptoms at the final timepoint. However, we did not find evidence for our second hypothesis; there were no prospective effects between depressive symptoms and financial toxicity.

Conclusions and Implications: Findings show a strong association between worse financial health and depressive symptoms in Black women with breast cancer that persists over a year and a half after diagnosis. It is possible that the lack of prospective effects may be due to the time interval of measurement; if financial toxicity affects depressive symptoms over days and weeks (as opposed to months), we would not have been able to detect that relationship. Findings suggest that depression and financial challenges are likely to co-occur, which means it is important to screen patients for both depression and financial toxicity throughout the treatment trajectory. Social workers may be able to provide crucial services such as navigation and psychosocial support, which may be beneficial for patients who face multiple challenges while dealing with cancer treatment.