Long-Term Financial Toxicity Has Substantial Impact on HRQoL Among Partners of Colorectal Cancer Survivors

TON - June 2023 Vol 16, No 3

A new study has found that partners of colorectal cancer survivors experienced long-term financial toxicity that was associated with worse health-related quality of life (HRQoL) due to systems- and individual-level behavioral factors (Ghazal LV, et al. JAMA Netw Open. 2023;6:e235897).

Financial toxicity—the often-overwhelming negative consequence of the cost of cancer and its treatment—is well documented among survivors, but little is known about long-term financial toxicity and its association with HRQoL among their partners. To develop interventions to mitigate the detrimental outcomes associated with financial toxicity in patients and their partners, appreciating the impact on partners themselves is critical.

In this study, investigators mailed surveys to survivors 1 to 5 years after survivors' stage III colorectal cancer diagnosis and included a separate survey for their partners (ie, spouse, domestic partner, or significant other living in the same household). Data analysis was performed from February 2022 to January 2023.

The surveys measured 3 intermediate outcomes of financial toxicity—financial burden, debt, and financial worry. The financial burden measure included multiple items (with yes or no responses) that assessed financial burden, such as cutting down on spending and missing credit card or bill payments “due to the financial impact of the patient having colorectal cancer.” Debt was measured with a yes or no question (ie, “Do you currently have debt due to the patient’s colorectal cancer treatment?”). Financial worry was measured on a scale of 1 to 5 using the Likert scale.

Responses from 307 partners revealed that 63% experienced 1 or more of the financial burden items, and younger partners were significantly more likely to report higher financial burden. According to the researchers, “this result is particularly salient given recent alarming increases in colorectal cancer incidence among patients aged younger than 50 years.”

Nearly one-third (28.6%) of partners reported current cancer-related debt, and more than one-third (35.5%) reported high financial worry. Partners with financial burden, debt, and financial worry also reported poorer HRQoL in the domains of pain interference, physical function, sleep disturbance, and social functioning.

In addition to systems-level factors such as high costs, multiple bills from different providers, challenges with health insurance, and missed or lost work/wages, compensatory individual-level factors also contributed significantly to financial toxicity. Partners described these factors in ways such as “uncharacteristic spending to cope with the cancer-related emotional burden,” or “disruption to social relationships as they asked for material support for medications, medical supplies and living costs.”

“The qualitative findings suggested that the impact of financial burden on HRQoL was substantial,” the researchers noted. “For example, one partner stated that the cancer diagnosis caused them to use savings (‘sell off retirement dreams’), sell belongings for money, and participate in financial crowdsourcing for medicines, medical supplies, and housing. Partners described debt-related mental health outcomes such as depression and ‘[spending] a lot of money to cope’ with cancer.”

Cancer survivors’ partners also described additional factors, such as the isolating nature of financial worry, as well as negative effects on intimacy.

Most partners described the financial toxicity of cancer as dependent on health insurance and employment status, but even when partners were not experiencing financial toxicity, they often questioned what might have happened without adequate employment, health insurance, or savings.

“The phenomenon of worrying about financial toxicity that they could have faced is similar to, although not as extreme as, catastrophizing—the psychological process of imagining the worst possible outcome—which has been associated with fatigue and pain among individuals with chronic disease, including cancer,” the investigators asserted.

According to the researchers, these findings contribute to the literature on financial toxicity and will help to better tailor multilevel interventions aimed at mitigating financial toxicity and improving HRQoL for both patients and partners.

They suggested that future interventions target the interplay of systems- and individual-level factors among patients and their partners, and incorporate more behavioral approaches to address social disruptions, uncharacteristic spending, and worry about “what could have been.”

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