Financial Distress Experienced by 40% of Patients with Cancer

August 2014 Vol 7, Special Issue ASCO 2014 Payers' Perspectives in Oncology
Caroline Helwick

Nearly 40% of patients with cancer experienced a higher financial burden than they expected, but the duration of their chemotherapy did not correlate with financial distress, according to a study of 300 patients by Duke University researchers.

There was no evidence of a correlation between subjective financial distress and the amount of time that a patient received treatment (P = .893), according to Lena Van Nimwegen, a third-year medical student at Duke. The senior investigator was S. Yousuf Zafar, MD, MHS, an oncologist at Duke.

Ms Van Nimwegen noted that although objective financial burden is known to correlate with treatment course, less is known about whether patients’ subjective report of financial distress follows similar trends during the course of treatment.

“Finding a trend in patients’ financial distress could help providers implement timely interventions to provide aid and relieve distress,” she suggested.

Financial distress related to cancer care often has far-ranging consequences, including nonadherence to treatment; the use of savings to pay for care; bankruptcy; and decreased spending on food, clothing, and leisure activities, she noted.

Cross-Sectional Study of 300 Adults
In this cross-sectional study of 300 insured adults with solid tumors receiving treatment for at least 1 month, most of the patients had incurable disease, at a referral center and 3 rural oncology clinics. Using a validated measure of financial distress, the researchers also asked about out-of-pocket expenses and extracted medical records.

On study enrollment, all patients (median age, 60 years) were insured, although 40% were underinsured; 97% had prescription drug coverage. The patients’ annual median household income was $60,000.

The patients’ time on treatment ranged from 1 month to >10 years. All participants were receiving chemotherapy or hormonal therapy at the time of the survey; 72% were receiving intravenous chemotherapy, 6% were receiving oral drugs, and 22% were receiving both.

Most Patients Report “Moderate” Financial Distress
The patients’ median monthly out-of-pocket cost was $591 for a median of 4.6 months. Their median financial distress score was 7.4 (on a scale of 1 to 10), corresponding to moderate distress, Ms Van Nimwegen reported.

Almost 40% of the patients reported experiencing a higher financial burden than they expected, and 16% reported “high or overwhelming” financial distress.

The main predictor of high financial distress was early-stage disease (ie, potentially curable cancer), which carried an odds ratio (OR) of 2.56 (P = .02). Factors associated with not reporting financial distress included:

  • Increasing age: OR, 0.77 (P = .01)
  • Employed versus unemployed: OR, 0.36 (P = .03)
  • Married versus unmarried: OR, 0.23 (P = .01)
  • Prescription drug coverage: OR, 0.11 (P = .03).

The group’s next steps are to further examine the various risk factors for financial distress during treatment and to find a way to monitor this “to ensure timely intervention,” she noted.

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Last modified: August 21, 2014
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