One in Five Older Patients with Advanced Cancer Face Serious Financial Hardship

According to new research from the University of Rochester, 18% of older patients with advanced cancer are experiencing financial difficulties due to the cost of their treatment that are negatively affecting their care, quality of life, and mental health.

The multi-center study of 542 patients ages 70-96 from across the United States examined this under-studied population and the impact of “financial toxicity” on anxiety, depression, and other factors related to quality of life (QoL).

The findings of this study will be presented at the American Society of Clinical Oncology’s (ASCO) upcoming Quality Care Symposium, taking place September 28–29, in at the JW Marriott Phoenix Desert Ridge in Phoenix, Arizona.

“The majority of patients with cancer are older, which means they’re living on restricted incomes and often don’t want to burden either their caregivers or kids,” said senior author Supriya Gupta Mohile, MD, MS, the Wehrheim Professor in the University of Rochester Medical Center’s Wilmot Cancer Institute.

“Their spouses may also have their own health care needs, and their finances have to cover many expenses other than cancer care, including food, medications, and housing. This is a vulnerable group we haven’t paid enough attention to as a society but really need to, especially as the older population continues to grow.”

Subjective measure
Because financial toxicity is a subjective measure without a standard definition, the authors developed an easy-to-use screening measure for patients with a cancer diagnosis based on the current literature and comprised of three basic questions. Patients were categorized as experiencing financial toxicity if they answered yes to any one of the following questions: (1) Have you ever delayed medications due to cost?; (2) Have you ever had insufficient income in a typical month for food or housing?; and (3) Have you ever had insufficient income in a typical month for other basic needs?

“We wanted to create a screening tool that wasn’t too time consuming or difficult for patients to fill out so that we could identify as many patients who are financially distressed as possible,” said lead author Asad Arastu, MSc, a medical student at the University of Rochester.

“This study shows that an alarming number of older cancer patients report delaying taking their medications or are unable to afford basic needs such as food and housing,” Arastu explains.

Anxiety and Depression
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%) than patients who do not report financial hardship. On average, patients experiencing financial toxicity scored higher on the Generalized Anxiety Disorder Scale-7—a widely used standard measurement tool for generalized anxiety disorder—higher on the Geriatric Depression Scale (indicating greater depression severity), and lower on the Functional Assessment of Cancer Therapy Scale-General (indicating lower quality of life).

Through baseline visits, the authors found that for patients who met the criteria for experiencing financial toxicity, cost issues were only brought up about half the time by the oncologists. The authors developed this screening tool as a way to prompt oncologists to ask their patients questions, which would create an opening to connect the ones who are experiencing financial hardship with a social worker or financial specialist.

The authors see the next step as increasing interventions to help patients and caregivers through standardized support to help older patients with cancer find all the available resources that can help them allay costs.


Last Editorial Review: September 24, 2018

Featured Image: Elderly patient, alone and stressed. Courtesy: © 2010 – 2018 Fotolia. Used with permission.

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