{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T03:49:09Z","timestamp":1790912949750,"version":"4.1.0"},"reference-count":42,"publisher":"American Society of Clinical Oncology (ASCO)","content-domain":{"domain":["ascopubs.org"],"crossmark-restriction":true},"short-container-title":["JCO Oncol Pract"],"abstract":"<jats:sec>\n                    <jats:title>PURPOSE<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>\n                      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]\n                      <jats:italic toggle=\"yes\">v<\/jats:italic>\n                      44% [95% CI, 30 to 63]) and no\/mild pain (40 [95% CI, 30 to 53]\n                      <jats:italic toggle=\"yes\">v<\/jats:italic>\n                      30% [95% CI, 21 to 42]).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSION<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1200\/op-25-00683","type":"journal-article","created":{"date-parts":[[2026,1,27]],"date-time":"2026-01-27T20:59:13Z","timestamp":1769547553000},"update-policy":"https:\/\/doi.org\/10.1200\/crossmark","source":"Crossref","is-referenced-by-count":3,"title":["Associations Between Cancer-Related Financial Hardship, Pain, and Opioid Use"],"prefix":"10.1200","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5328-7517","authenticated-orcid":true,"given":"Courtney P.","family":"Williams","sequence":"first","affiliation":[{"name":"Division of General Internal Medicine &amp; Population Science, University of Alabama at Birmingham, Birmingham, AL"},{"name":"O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5452-6452","authenticated-orcid":true,"given":"Sandra","family":"Olisakwe","sequence":"additional","affiliation":[{"name":"Division of Hematology &amp; Oncology, University of Alabama at Birmingham, Birmingham, AL"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joud","family":"El Dick","sequence":"additional","affiliation":[{"name":"Division of Hematology &amp; Oncology, University of Alabama at Birmingham, Birmingham, AL"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luqin","family":"Deng","sequence":"additional","affiliation":[{"name":"Division of General Internal Medicine &amp; Population Science, University of Alabama at Birmingham, Birmingham, AL"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9883-1424","authenticated-orcid":true,"given":"Andres","family":"Azuero","sequence":"additional","affiliation":[{"name":"School of Nursing, University of Alabama at Birmingham, Birmingham, AL"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9329-3268","authenticated-orcid":true,"given":"Maria","family":"Pisu","sequence":"additional","affiliation":[{"name":"Division of General Internal Medicine &amp; Population Science, University of Alabama at Birmingham, Birmingham, AL"},{"name":"O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ellen","family":"Eaton","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4188-9785","authenticated-orcid":true,"given":"Gabrielle B.","family":"Rocque","sequence":"additional","affiliation":[{"name":"O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL"},{"name":"Division of Hematology &amp; Oncology, University of Alabama at Birmingham, Birmingham, AL"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"233","published-online":{"date-parts":[[2026,1,27]]},"reference":[{"key":"e_1_3_6_2_2","doi-asserted-by":"publisher","DOI":"10.1200\/OP.21.00875"},{"key":"e_1_3_6_3_2","doi-asserted-by":"publisher","DOI":"10.3389\/fphar.2021.706289"},{"key":"e_1_3_6_4_2","doi-asserted-by":"publisher","DOI":"10.18553\/jmcp.2018.24.1.56"},{"key":"e_1_3_6_5_2","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.28262"},{"key":"e_1_3_6_6_2","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/djw205"},{"key":"e_1_3_6_7_2","doi-asserted-by":"publisher","DOI":"10.3390\/cancers15030591"},{"key":"e_1_3_6_8_2","volume-title":"Pain (PDQ\u00ae). 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