Financial Stress in Cancer Patients Creates Barrier to Care


Treating financial toxicity in cancer patients similarly to other side effects could improve outcomes.

A questionnaire demonstrated its ability to measure a cancer patient’s risk for, and tolerability of, financial stress.

Comprehensive Score for Financial Toxicity (COST) is a short survey that includes 11 brief statements regarding costs, concerns, and resources. In a study published in Cancer, a team of specialists used the questionnaire to gather data from 233 patients undergoing treatment for advanced cancers.

“As expected, we found a strong association between a patient’s use of health care resources and his or her sense of financial toxicity,” said lead study author Jonas de Souza, MD, MBA. “This is something we need to look for, to recognize early and make sure it does not become a barrier to care.”

After researchers examined the responses, they were able to identify patients at financial distress, which was found to be a “clinically relevant patient-centered measure.”

For example, more than 2 hospital admissions were found to have a significant impact on a patient’s sense of financial toxicity.

“This is reasonable,” de Souza said. “Hospital care is much more expensive than office-based care. We now know that it also impacts a patient’s self-reported financial feelings.”

During the questionnaire, participants were asked to circle 1 of 5 possible responses for each of the questions to help determine their level of concern.

Statements included: “I feel financially stressed,” or “My out-of-pocket medical expenses are more than I thought they would be.”

Several factors were found to be closely linked to financial toxicity, with employment status at the top of the list. This was followed by household income, psychological distress, the number of hospital admissions, and race.

On average, African American participants tended to have more financial toxicity than Caucasians. One surprise was the lack of perceived financial benefit from participation in clinical trials, according to the study.

“Usually the maker of an innovative device or the company that supplies a new drug will pick up the costs related to the investigational drug,” de Souza said. “But that did not reduce our patients’ sense of financial toxicity. We’ve added that to our model.”

The authors noted that the next step in the process is to go back to the patients and examine the factors that drive financial toxicity for each type of cancer, in order to understand how best to intervene and how to decrease costs for cancer treatment overall.

“The financial distress identified by the COST scale captures a unique set of stressors affecting patients above and beyond the physical and psychological strains of their disease,” said researcher Lauren Hersch Nicholas, PhD. “Being able to quantify this burden is an important step towards giving patients, their families and care team the information necessary to make the best treatment decisions for each patient’s situation.”

The findings highlight the need to take a patient’s financial toxicity into consideration in the process of cancer treatment.

“As society increasingly considers the costs incurred by patients with cancer as a side effect of treatment, instruments to measure financial toxicity should be patient centered, scientifically derived, and clinically relevant,” the researchers noted. “It is time to start measuring and talking about the costs of care for patients as we would with any other side effect.”

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