2018 Quality Care: Older Patients With Advanced Cancer Experiencing Financial Difficulties Have Worse Quality of Life and Mental Health

Key Points

  • Older patients with advanced cancer experiencing financial difficulties due to their treatment costs had more severe anxiety and depression and a poorer quality of life compared with patients who do not experience financial hardship during treatment.
  • For those patients having financial difficulty, cost issues were raised only about half the time by their oncologists.
  • Oncologists can provide assistance to vulnerable older patients in financial distress by referring them to a social worker or financial specialist.

Older patients with advanced cancer experiencing financial toxicity due to the cost of their treatment have higher rates of severe anxiety and depression and poorer quality of life than patients who do not experience financial hardship. In addition, for those patients having financial difficulty, cost issues were raised only about half the time by their oncologists. The study will be presented by Arastu et al during ASCO’s 2018 Quality Care Symposium, to be held September 28–29 in Phoenix (Abstract 87).

Study Methodology

The researchers analyzed data on 542 patients aged 70–96 from a geriatric assessment intervention study conducted by the University of Rochester NCI Community Oncology Research Program across 31 practice sites. Patients were categorized as experiencing financial toxicity if they reported any one of the following: delaying medications due to cost, insufficient income in a typical month for food and housing, or insufficient income in a typical month for other basic needs.

Patients were also asked to complete the Generalized Anxiety Disorder-7 (GAD7) test to evaluate anxiety; the Geriatric Depression Scale (GDS) to assess depression; and the Functional Assessment of Cancer Therapy-Generation (FACT-G) test to measure overall quality of life (QoL). Associations of financial toxicity with anxiety, depression and QoL were assessed in separate multivariate linear regression models controlling for covariates at P < .1.

Study Results

The researchers found that patients experiencing financial toxicity had a higher prevalence of severe anxiety (18% vs 7%); a higher prevalence of depression (27% vs 21%); and a higher prevalence of poor quality of life (41% vs 22%) compared to patients who do not report financial hardship.
Through baseline visits, the researchers found that for patients who met the criteria for experiencing financial toxicity, cost concerns were raised only about half the time by the patients’ oncologists.

Identifying Patients Under Financial Distress

The researchers developed a three-question screening measure for oncologists to identify vulnerable older patients experiencing financial toxicity, allowing providers to intervene sooner with referrals to a social worker or financial specialist. Patients were categorized as experiencing financial toxicity if they answered “yes” to any of these three questions:

  • Have you ever delayed medications due to cost?
  • Have you ever had insufficient income in a typical month for food or housing?
  • Have you ever had insufficient income in a typical month for other basic needs?

“Older patients with advanced cancer who experience income- and cost-related barriers to quality cancer care reported worse anxiety, depression, and quality of life than those without financial toxicity. Given the association between financial toxicity and these outcomes, these three financial toxicity questions may help identify vulnerable older patients and allow providers to intervene sooner and thereby enhance the quality of care patients receive,” concluded the study authors.

To see a full list of author disclosures, refer to the study abstract.

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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