Study Supports Financial Screening in Cancer Patients

Nick Mulcahy

October 22, 2014

In a survey of nearly 1600 cancer survivors, about one quarter (27%) reported at least one money problem related to their cancer, such as debt, bankruptcy, or financial "sacrifices", and more than a third (37%) reported modifying their work in some manner, such as delaying retirement or taking extended time off.

Women, racial minorities, patients younger than 65 years, and patients receiving active cancer treatment had inflated risks for financial and employment difficulties, said lead author of the study, Robin Whitney, RN, a doctoral candidate in nursing at the University of California, Davis.

The study is "one of the first" to look at the disparities of these burdens and to use patient-reported data, said Whitney.

She discussed the results during a presscast in advance of the inaugural Palliative Care in Oncology Symposium, which will be held October 24 and 25 in Boston

The study is evidence that "screening and support for financial and work concerns are needed across the survivorship trajectory," said Whitney.

Another expert agrees that the idea should be explored.

This study "suggests to us that screening for these issues might be an important part of cancer care," said presscast moderator Jyoti Patel, MD, from the Robert H. Lurie Comprehensive Cancer Center of Northwestern University in Chicago.

There are 12 million cancer survivors in the United States, so there are large numbers of people at risk for the twin challenges of financial hardship and work struggles, said Dr Patel. In particular, there is a need to find "creative ways" to deal with the financial problems, she said.

The results of the study are generalizable to the American population, said Whitney. The data source, the 2011 Medical Expenditures Panel Survey Experiences With Cancer Survivorship Supplement (n = 1592), is a nationally representative group, she said.

Among the survivors surveyed, 47% were younger than 65 years, 56% were female, 88% were white, and 4% were uninsured.

With regard to treatment status, 14% were in active treatment, 46% had completed treatment less than 5 years before, and 39% had completed treatment more than 5 years before.

Financial difficulties were defined in the survey as borrowing money, incurring debt, filing for bankruptcy, worrying about/being unable to cover medical costs, and making financial sacrifices.

Work modifications were defined as delaying or taking an early retirement, changing to a flexible schedule or a less demanding job, not taking a promotion, and taking an extended or unpaid leave.

There were significant predictors of financial difficulties. Patients in active treatment reported 92% more difficulties than those 5 years beyond treatment (odds ratio [OR], 3.2; 95% confidence interval [CI], 2.1 - 5.0), patients younger than 65 years reported 130% more difficulties than older people (OR, 2.4; 95% CI, 1.7 - 3.3), patients with no insurance reported 67% more difficulties than those with insurance (OR, 2.4; 95% CI, 1.3 - 4.4), and nonwhite patients reported 41% more difficulties than white patients (OR 1.7; 95% CI, 1.1 - 2.6).

There were also significant predictors of work modification. Patients in active treatment reported 40% more modifications than those 5 years beyond treatment (OR, 2.9; 95% CI, 1.7 - 4.9), females reported 30% more modifications than males (OR ,1.5; 95% CI, 1.1 - 2.2), and nonwhite patients reported 54% more modifications than white patients (OR 1.7; 95% CI, 1.1 - 2.6).

This study adds to a growing body of literature on the financial status and challenges of cancer patients, as reported by Medscape Medical News.

Financial concerns and lack of insurance have been shown to affect survival and access to care among cancer patients. And adults diagnosed with cancer are twice as likely to declare bankruptcy as adults without cancer.

Complaints related to the cost of cancer treatment warrant a new term — "financial toxicity," according to researchers. A scale to identify such toxicity has been proposed.

Ms Whitney and Dr Patel have disclosed no relevant financial relationships.

2014 Palliative Care in Oncology Symposium: Abstract 238. To be presented October 24, 2014.

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