Associations between cancer patients' advance care and financial planning and surviving spouses' financial well-being.

Abstract

6567 Background: The “financial toxicity” associated with cancer treatment, including high out-of-pocket expenses and lost earnings, may have lasting financial effects for surviving spouses. Although advance care planning (ACP) is used as a cancer quality metric, the value of financial planning is unknown. Methods: We examined associations between cancer patients’ written ACP and financial planning (will) and surviving spouses’ financial well-being using prospective, nationally representative data from the 2004-2014 waves of the Health and Retirement Study. We assessed change in household, non-housing (financial) wealth, including debt, among 962 surviving spouses of cancer decedents. Because wealth varies widely in the US, we fit multivariable quantile regression models at the 25th, 50th, and 75th percentiles to examine associations between cancer decedents’ ACP, financial planning, and wealth, adjusting for sociodemographic characteristics. Results: Among cancer decedents, 33% completed both ACP and a will, 27% only a will, 10% only ACP, and 30% neither. The median wealth of surviving spouses was $22,309 (25th percentile = $0, 75th percentile = $134,238). Among spouses of cancer decedents in the 25th percentile of wealth before death, completion of ACP and a will was associated with $5,348 (95% CI = $1,172-$9,523) more financial wealth after death compared with no planning. Use of ACP and a will was also associated with $46,851 (95% CI = $2,810-$90,891) more financial wealth at the 75th percentile. There were no differences in the wealth of surviving spouses after death between patients who completed only a will, only ACP, or no planning (Ps > .09). Conclusions: Completion of ACP and financial planning was associated with greater wealth among both affluent and non-affluent surviving spouses compared with no planning. Efforts to sensitively incorporate financial planning into cancer patients’ care have the potential to improve surviving family members’ financial well-being.