Financial Toxicity in Lung Cancer: An Assessment of Magnitude, Perception, and Impact on Quality of Life

Abstract

Advances in lung cancer therapy have resulted in improved clinical outcomes. Unfortunately, advances can come at a financial cost to patients and their families, posing significant risk to overall quality of life. Financial distress has been previously shown to be associated with increased symptom burden and decreased treatment compliance, but the magnitude of financial distress is not well characterized in lung cancer populations. This prospective study aims to quantify the relationship between financial toxicity, quality of life, and out of pocket expenses among patients with newly diagnosed lung cancer. We present here the results of the initial enrollment period. Patients with AJCC stage II-IV newly diagnosed lung cancer, initiating first line therapy, were recruited in an IRB approved prospective study at a single tertiary academic institution. Baseline sociodemographic and household financial information was collected; Comprehensive Score for Financial Toxicity (COST) was used to assess financial toxicity and the Functional Assessment of Cancer Therapy-Lung (FACT-L) was used to assess quality of life (QOL). Associations between financial toxicity and baseline variables were assessed using multivariable analysis and correlations were assessed using Pearson correlation. 103 patients were approached and 97 patients were enrolled (94%) between July 2018 and February 2019. Median age was 64 years (35-90), 52% of patients were male (n=50) and 77% were Caucasian (n=75). Among our population, 39% (n=38) reported that they were either “just getting on” or “struggling” financially. 23% (n=22) had to make significant life sacrifices because they were short on money and 14% (n=14) had to use accumulated savings or retirement to pay for medical expenses. Of those patients who were not retired, 45% (n=21/47) had a change in income since their cancer diagnosis. Increased financial toxicity was associated with being unable to meet day-to-day expenses (p=0.002) and having <1 month of savings (p=0.02) after adjusting for other factors such as age, race, work status, insurance, and income on multivariate analysis. Increased financial toxicity was found to be correlated with a decrease in QOL as measured by the FACT-L (correlation coefficient [r]=0.41, p<0.001). Patients’ estimation of their out-of-pocket (OOP) expenses for the upcoming 6 months ranged from $30-$50,000 (median $2,263). There was no correlation between anticipated OOP expenses and either financial toxicity (r=-0.18, p=0.08) or QOL (r=-0.02, p=0.86). Financial distress is common among patients with newly diagnosed lung cancer and is associated with decreased quality of life during lung cancer therapy. These data provides key factors for identification of patients at risk for financial distress. Furthermore, they provide a framework for further studies to explore the benefit of financial counseling interventions which may improve quality of life and oncologic outcomes.