Financial Toxicity Concerns are Associated With Overall Levels of Patient Reported Distress During Radiation Therapy

Abstract

We examined the association between patient reported financial toxicity (PRFT), Overall Survival (OS), and overall PRD in radiotherapy patients. 518 consecutive patients who underwent radiotherapy (RT) at an academic medical center between March 2012 and May 2016 were included in this retrospective study. Only patients were included. Information was collected regarding age at the start of RT, gender, type of RT (curative or palliative), cancer primary site, RT dose, metastatic disease, chemotherapy, surgery, and survival. Patient reported distress level was also assessed and ranges from 0 (the lowest) to 10 (the highest). Levels of concern regarding out of pocket costs and regarding finances were the primary measures of this study, and both of these measures were scored as either “not at all”, “a little bit”, “somewhat”, “quite a bit”, or “very much”. Baseline patient characteristics of these concerns were compared using Fisher’s exact test or a Kruskal-Wallis rank sum test. Associations between baseline patient characteristics and survival after the start of RT were evaluated using single variable (i.e. unadjusted) Cox proportional hazards regression models. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated. Associations of level of concern regarding out of pocket costs and level of concern regarding finances with survival after RT were evaluated using single variable and multivariable Cox proportional hazards regression models. Overall PRD level and concern regarding out of pocket costs were positively correlated (P<0.001). Additionally, there was a significant association between cancer primary site and level of concern regarding out of pocket costs (P=0.008), with level of concern highest for breast cancer, head and neck cancer, and musculoskeletal cancer. There were no other statistically significant associations between baseline characteristics and level of concern regarding out of pocket costs. Overall PRD level was significantly higher for patients expressing a greater level of concern regarding finances (P<0.001) as well as for younger patients (P=0.03). There was not a significant between either measures of financial distress in survival in single-variable analysis or in multivariable analysis adjusting for potential confounding variables. For curative RT patients, there was a significantly higher overall distress level as level of concern regarding out of pocket costs increased (P<0.001) and finances (P<0.001), but not for palliative RT patients for either measure. Correlations between concern for out of pocket costs and distress highlight the existence of sources of distress external to therapeutic treatments. The significance of younger patients reporting greater PRD scores also points to concern regarding early onset financial insecurity.