Moderate and Severe Financial Distress Among Advanced Cancer Patients Assessed in a Supportive Care Outpatient Center

Abstract

Advanced cancer patients(AdCa) experience physical, psychological, existential/spiritual distress and financial distress(FD) associated with the disease or treatment. Regular assessments of these issues in the outpatient-setting are limited. We reviewed 289 consults of AdCa evaluated by our Supportive Care Outpatient-Center between October-2012 and January-2013. We used Edmonton Symptom Assessment Scale adding two items following the same scale (0 to 10) to evaluate: Spiritual Pain and FD, (ESAS-FS). We determined the frequency, intensity and correlates of Moderate to Severe (≥ 4/10) self-reported FD (Distress/Suffering experienced secondary to financial issues) among these AdCa. Mean age (range): 60.1 years (22-92). 53% were male. 189 (65%) were White, 45 (15%) African American, and 34 (12%) were Hispanic. Type of cancer: head and neck 62 (21%), gastrointestinal 57 (20%), breast 40 (14%), lung 32 (11%), urological 32(11%), and others 45(16%). 119/289 (41%) AdCa had Moderate to Severe FD. AdCa with Moderate-Severe FD had worse Pain [mean (95% CI) 5.69 (5.1, 6.2) vs. 4.3 (3.6, 4.9)] (p<0.001), depression [4.3(3.7, 4.9) vs. 1.5 (1.1, 2.1), p<0.0001], anxiety [4.6 (4, 5.2 vs. 1.6 (1.1, 2.1), p<0.0001], Well-Being [5.6 (5.1, 6.1) vs. 4.3 (3.7, 4.9), p<0.0001], and Spiritual Pain [2.9(2.3, 3.5) vs. 0.5 (0, 1.0), p<0.0001]. FD correlated (Spearman) with Pain r=0.25, p<0.0001; Sleep r=0.29, p<0.0001; Depression r=0.41, p<0.0001; Anxiety r=0.45, p<0.0001; Drowsiness r=0.26, p<0.0001, Well-being r=0.25, p<0.0001; and Spiritual Pain r=0.44, p<0.0001. Logistic regression multivariate analysis showed association with Spiritual Pain [OR (95% Wald CI) 1.575(1.284-1.932), p<0.0001] and Anxiety [1.261 (1.083- 1.488), p<0.0001]. Moderate to Severe FD was reported in more than 40% of AdCa. It correlates with physical and psychological, and spiritual distress. The use of ESAS-FS allows identifying AdCa with Moderate to Severe FD evaluated in a Supportive Care Outpatient Clinic. More research and interventions are needed.