Patient-reported financial toxicity and adverse medical consequences in head and neck cancer.

Abstract

Financial toxicity (FT) is a significant barrier to high-quality cancer care, and patients with head and neck cancer (HNCA) are particularly vulnerable given their need for intensive support, daily radiotherapy (RT), and management of long-term physical, functional, and psychosocial morbidities following treatment. We aim to identify predictors of FT and adverse consequences in HNCA following RT. We performed a prospective survey study of patients with HNCA seen in follow-up at an academic comprehensive cancer center (CCC) or Veterans Affairs hospital between 05/2016 and 06/2018. Surveys included validated patient-reported functional outcomes and the COST measure, a validated instrument for measuring FT. The response rate was 86% (n=63). Younger age and lower median household income by county were associated with lower COST scores (i.e., worse FT) on multivariable analysis (p=.045 and p=.016, respectively). Patients with worse FT were more likely to skip clinic visits (RR (95% CI) 2.13 (1.23-3.67), p=.007), be noncompliant with recommended supplements or medications (1.24 (1.03-1.48), p=.02), and require supportive infusions (1.10 (1.02-1.20), p=.02). At the CCC, patients with worse FT were more likely to require feeding tubes (1.62 (1.14-2.31), p=.007). Overall, 36% reported that costs were higher than expected, 48% were worried about paying for treatment, and 33% reported at least a moderate financial burden from treatment. HNCA patients experience substantial FT from their diagnosis and/or therapy, with potential implications for medical compliance, QOL, and survivorship care.