In a single-institution study reported in JCO Oncology Practice, Smith Giri, MD, MHS, and colleagues found that 27% of patients with cancer aged 60 or older reported financial distress in response to a query prior to starting systemic therapy. Numerous demographic and geriatric assessment characteristics were associated with a greater risk of financial distress.
Study Details
The study included 447 patients with cancer age 60 or older in the University of Alabama at Birmingham Cancer and Aging Resilience Evaluation Registry. Patients underwent geriatric assessment during initial consultation with a medical oncologist before starting systemic therapy. Financial distress status was elicited using a single-item question: “Do you have to pay for more medical care than you can afford?”
“More than a quarter of older adults with cancer reported financial distress at the time of initial presentation to an oncologist. Several demographic factors and geriatric assessment impairments were associated with financial distress.”— Smith Giri, MD, MHS, and colleagues
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Patients had a median age of 69 years (interquartile range = 64–75 years); 60% were men; 75% were White and 23% were Black; and the most common cancers were colorectal (26%), pancreatic (19%), and hepatobiliary (13%) cancers, with 72% of all patients having stage III/IV disease. Overall, 59% of patients were retired and 19% were employed; 52% had Medicare, 42% had private insurance, 3% had Medicaid, and 4% had uninsured/self-pay status.
Key Findings
In total, 121 (27%) of 447 patients reported financial distress. Patients with financial distress were more likely to be non-White (40% vs 20%, P < .001), have an educational level of high school graduate or lower (52% vs 38%, P < .001), be disabled or unemployed (30% vs 10%, P < .001), and be uninsured/self-paying (7% vs 2%, P = .039). No significant differences in cancer type or stage were observed between patients with vs without financial distress.
On multivariate analysis, factors associated with financial distress were being Black vs White (odds ratio [OR] = 2.26, P = .002), being disabled/unemployed vs employed (OR = 2.60, P = .019), and having an advanced degree vs less than high school completion (OR = 0.13, P = .012).
In analysis adjusted for age, sex, education, marital status, employment, cancer type, and cancer stage, patients with financial distress were more likely to report numerous geriatric assessment impairments, including depression (OR = 2.10, P = .034), history of at least one fall (OR = 2.39, P = .002), any activities of daily living dependence (OR = 1.98, P = .014), nine or more medications (OR = 2.02, P = .010), and hearing deficit (OR = 1.80, P = .024).
Patients with financial distress were more likely to report impaired health-related quality of life (as measured by the Patient-Reported Outcomes Measurement Information System [PROMIS] 10-item Global Health scale) in both physical health (T score: β = −2.82, P = .014) and mental health domains (T score: β = −3.31, P = .002).
The investigators concluded, “More than a quarter of older adults with cancer reported financial distress at the time of initial presentation to an oncologist. Several demographic factors and geriatric assessment impairments were associated with financial distress.”
Dr. Giri, of the Institute for Cancer Outcomes and Survivorship, Division of Hematology-Oncology, University of Alabama at Birmingham, is the corresponding author for the JCO Oncology Practice article.
Disclosure: The study was supported by the Walter B. Frommeyer Fellowship in Investigative Medicine at the University of Alabama at Birmingham and National Cancer Institute. For full disclosures of the study authors, visit ascopubs.org.
