Treatment costs pose major financial stress for patients.

Abstract

Financial distress, also known as financial toxicity, is a major concern for both patients with metastatic breast cancer and older patients with cancer according to studies presented at the American Society of Clinical Oncology’s Quality Care Symposium in September 2018. In one analysis, researchers from the University of North Carolina Lineberger Comprehensive Cancer Center surveyed 1054 patients with metastatic breast cancer from 41 states, approximately one-third of whom were uninsured. Patients in the uninsured group were more likely to identify as a racial or ethnic minority, have a lower income, and work full-time. Compared with the insured study participants, they were more likely to refuse or delay a treatment because of its cost (96% vs 36%) and more often reported being contacted by a collection agency (92% vs 30%). Other hardships that uninsured participants were more likely to experience included the inability to meet monthly expenses and not feeling in control of their financial situation. However, researchers found that having health insurance did not necessarily shield patients from the psychological impact of high cancer costs. fte insured group reported having greater emotional distress related to disease costs, including feeling “quite a bit” or “very” stressed about not knowing treatment costs (41% vs 24%) and feeling that a greater amount of financial stress had been put on their families because of their disease (36% vs 19%). Although clinicians do not have control over treatment costs, researchers say that the findings can provide guidance in helping patients to cope with financial burdens and associated stress brought on by high medical bills. A separate study, led by investigators at the University of Rochester, found that 18% of older patients with advanced cancer experienced financial difficulties that negatively affected their care, quality of life, and mental health. Researchers surveyed 542 patients aged 70 to 96 years nationwide. Because financial toxicity lacks a standardized definition, they used a simple screening tool to categorize patients. Seniors were reported to have experienced financial toxicity if they answered yes to 1 of 3 questions: had they ever delayed medications for cost reasons, did they have insufficient income for food and housing in a typical month, and did they have insufficient income for other basic needs. Older patients, investigators noted, are more frequently diagnosed with cancer and often face the additional burden of limited incomes. Compared with those without financial hardships, older patients grappling with financial toxicity were found to have a higher prevalence of severe anxiety (18% vs 7%), a higher prevalence of depression (27% vs 21%), and a higher prevalence of poor quality of life (41% vs 22%). Moreover, for patients who met the criteria for financial toxicity, cost issues were brought up just about half the time by their clinicians. Researchers hope that the study will help oncologists to ask specific questions of their patients in order to connect them with social workers or financial specialists for help.