A qualitative exploration of the impact of ovarian cancer on the well-being of women: evaluating the intersection and influences of social determinants of health

Abstract

<h3>Objectives:</h3> Women with ovarian cancer (OC) may experience long-term financial burdens due to ongoing effects of disease and treatment. We qualitatively explored the interplay of social determinants of health such as economic stability, access to health care, and the social and community context in the lives of OC survivors. <h3>Methods:</h3> Participants were recruited by purposive sampling for semi-structured interviews. Interviews were audio-recorded, transcribed verbatim and coded. Framework analyses guided content analysis using ATLASti.V8. <h3>Results:</h3> 40 women with recurrent OC completed interviews between Dec. 2017 and Nov. 2018 (Table 1). Median age was 59.3 yrs (range 32.1-77.6). Median time from diagnosis was 44.7 months. A dominant theme was economic instability due to loss of financial independence or increased debt from care. On not working, a patient stated: "It affects everything you do, every part of your life. You worry. You know, it's like, ‘Am I gonna be homeless with cancer?' ‘Am I gonna be without heat with cancer?' ‘Am I gonna have enough food?'" Modifications of spending on food was common. "Even at the grocery store, cutting out the … food … just the junk food, I would call it. Cutting that out and, you know, changing the way I cook. A lot of, you know, pasta dishes, rice. things that have maybe a little meat in them. You know, some little chopped chicken, but just make even the chicken stretch, you know." High co-pays and insurance coverage were structural barriers directly impacting care. Some chose to cancel appointments due to prohibitive costs. "… I cancelled my scans in April, where I'm going every four months instead. Since I have to pay so much for the scans, I think three a year is going to be a little more manageable than four a year." Impacts from economic instability on the social well-being of patients were striking. "When I did not work. the first three to four months seemed like it was okay.and then after that, it got to be extremely depressing. I felt like I was not a participant of society". Eliminating social activities to manage costs was common. ". We used to go to festivals and stuff on the weekends. We used to go out to eat. We don't do any of that anymore. The money just isn't there for that." Another stated, "… my granddaughter, used to like to go to the football games. I can't take her to those. We don't go to the movies. We just sit home and do nothing. I try to keep her entertained by, you know, playing little games with her and stuff like that, but otherwise we don't do anything." Another explained, "we've cut out, well, things we used to do. You know, like going out to eat and just going out with friends, and we used to have a 4th of July party every year. We live out in the country and we would have fireworks and … invite friends and family and we've quit doing that. We haven't done that since I've been diagnosed with cancer, but we haven't borrowed any money. We've just quit doing things that we always enjoyed doing." <h3>Conclusions:</h3> Social determinants of health influence well-being of patients. In this qualitative study we found that economic instability and structural barriers negatively impacted both social well-being and access to care for some women with recurrent OC. We identified a striking theme of social isolation resulting from economic factors across the spectrum of annual income. Further understanding of these impacts can help inform interventions to enhance the overall welfare of patients and their families.