Financial Stress in Patients With Locally Advanced Head and Neck Cancer

Key Points

  • A total of 69% of patients with locally advanced head and neck cancer used at least one cost-coping strategy during the first 6 months of treatment.
  • Perceived social isolation was associated with use of coping strategies and nonadherence to treatment.

In a single-institution study reported in the Journal of Oncology Practice, de Souza et al found that two-thirds of patients with locally advanced head and neck cancer had to use a financial coping strategy to help pay for care within the first 6 months of treatment.

Study Details

The study involved 73 treatment-naive patients with stage III, IVa, or IVb locally advanced head and neck cancer at a tertiary care hospital (University of Chicago) seen from May 2013 to November 2014. Cost-coping strategies included selling possessions or property, using personal savings, borrowing money and taking credit card loans, and having family members work more hours to pay for costs associated with cancer during the 6-month study period. Health-care utilization was measured by hospital admissions and outpatient appointments on a 6-month timeline.

Use of Coping Strategies

Overall, 51 patients (69%) used at least one cost-coping strategy; 62% used all or a portion of savings, 42% borrowed money or used credit, 25% sold possessions or property, and 23% had family members work more hours.

On multivariate analysis, use of coping strategies was more likely for Medicaid patients vs privately insured patients (odds ratio = 42.3, P = .0042), patients with decreased wealth (OR = 0.946 per $10,000 increase, P = .002), and those with higher total out-of-pocket costs (OR = 1.07 per $1,000 increase, P = .003). Patients with high perceived social isolation were more likely to use cost-coping strategies (OR = 11.5, P =.01), report nonadherence to supportive medications (21.4 vs 5.45 days over 6 months, P = .0278), and miss appointments (7 vs 3, P = .0077).

The investigators concluded: “A majority of patients used at least one cost-coping strategy during their treatment, highlighting the financial stress that patients experience. Perceived social isolation is an important social determinant of increased medication nonadherence, missed appointments, and use of cost-coping strategies. Interventions should be investigated in at-risk patients who may suffer from financial stress.”

The study was supported by a grant from the Cancer Research Foundation and the Summer Research Program at The University of Chicago Pritzker School of Medicine.

Jonas A. de Souza, MD, MBA, of The University of Chicago, is the corresponding author of the Journal of Oncology Practice article.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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