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Financial Distress Unexpected by 40% of Cancer Patients

TON - July/August 2014 Vol 7 No 4 - Financial/Insurance Information
Caroline Helwick

Nearly 40% of cancer patients experienced a higher financial burden than they expected, but the duration of their chemotherapy did not correlate with financial distress, according to a Duke University study of 300 patients with cancer. The study results were presented at the American Society of Clinical Oncology 2014 annual meeting.

There was no evidence of a correlation between subjective financial distress and the amount of time that a patient received treatment (P = .8931), according to Lena Van Nimwegen, a third-year medical student at Duke. The senior author was S. Yousuf Zafar, MD, MHS.

Van Nimwegen noted that while objective financial burden is known to correlate with treatment course, less is known about whether patients’ subjective reports of financial distress follow 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,” Van Nimwegen said.

Financial distress related to cancer care often has far-ranging consequences, including nonadherence to treatment, 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
Van Nimwegen led a cross-sectional study of insured adults with solid tumors receiving treatment for at least 1 month. Using a validated measure of financial distress, the researchers surveyed 300 patients, mostly with incurable disease, at a referral center and 3 rural oncology clinics. They also asked about out-of-pocket expenses, and used disease and treatment information extracted from medical records.

Upon study enrollment, all patients (median age 60 years) were insured (though 40% were underinsured), and 97% had prescription drug coverage. Median household income was $60,000 a year.

The patients’ time on treatment ranged from 1 month to more than 13 years. All participants were receiving chemotherapy or hormonal therapy at the time of the survey; 72% were on intravenous chemotherapy, 5% were on oral drugs, and 22% were on both.

Most Patients Reported “Moderate” Financial Distress
The patients’ median monthly out-of-pocket cost was $592 for a median time on treatment of 4.6 months. Their median financial distress score was 7.4 (out of 10), corresponding to moderate distress, she reported.

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

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

  • 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 research group’s next steps will be to further examine various risk factors for financial distress during treatment and to find a way to monitor this “to ensure timely intervention,” she said.

Reference
Van Nimwegen L, Rushing C, Ladd Chino F, et al. Does cancer treatment-related financial distress worsen over time? Presented at: 50th Annual Meeting of the American Society of Clinical Oncology; May 30-June 3, 2014; Chicago, IL. Abstract 6559.

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Last modified: September 9, 2019