Increasing financial burdens among cancer survivors affect quality of life and how a patient views the quality of their care, according to researchers at Duke University.

The findings, which were recently reported in the Journal of Oncology Practice, explore the concept of “financial toxicity” among patients with cancer and how it may affect a patient’s outlook and outcomes.

Ultimately the research indicates that financial burdens are prevalent among cancer survivors and those financial burdens affects their perceived quality of care.1

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The researchers surveyed advanced and/or recurrent cancer patients (53% male and 76% white).  The study included 1,000 patients and the median age was 64 years.  “We did this study to better understand the extent to which financial toxicity impacted patients’ well-being. This study suggests that financial toxicity’s reach is well beyond the patient’s wallet,” said lead study author Yousuf Zafar, MD, MHS, of Duke University in Durham, NC.

In this prospective observational study, all the patients had been diagnosed with colorectal or lung cancer; 889 patients (89%)  were cancer free and 111 patients (11%) had advanced cancer.  All the patients were enrolled from 2003 to 2006 within 3 months of diagnosis, surveyed at baseline and then again at a median of 7.3 years from diagnosis. 

The researchers found that overall 482 patients (48%) reported difficulties living on their household income.  Most patients were very pleased with their care and 396 patients (41%) believed their health care to be “excellent” while 334 patients (35%) reported “very good care”.  However, the study also showed that a high financial burden was a prevalent problem and was associated with lower household income, younger age, and poorer quality of life. 

“The oncologist’s role is to ensure patients are assessed for financial toxicity in the same way they are assessed for physical toxicity. This screening could be as simple as checking in occasionally about whether the costs of care are tolerable.  Prior to starting treatment with an oral drug, just inquiring whether the patient has prescription drug coverage that could save thousands,” Dr. Zafar told Cancer Therapy Advisor

Dr. Zafar also highlighted the importance of a multidisciplinary team, including pharmacists, social workers, and financial counselors, to share the responsibility of checking on these issues.

Dr. Zafar said part of the problem is that many patients are too embarrassed to even mention financial strains and some worry that simply discussing strained finances could result in a lower quality of care. He said one of the strengths of the study is that all the patients were enrolled from varied geographic regions and diverse health care setting.

The patients were from five geographic regions, five integrated health care systems in the National Cancer Institute (NCI)’s Cancer Research Network, or 15 Veterans Administration (VA) Hospitals.

RELATED: Helping Patients With Cancer Avoid Financial Toxicity

Dr.  Zafar said studies suggest that approximately 50% of all Medicare beneficiaries with cancer spend at least 10% of their income on out of pocket expenses related to cancer care. “It’s difficult to know if the problem will lessen under the Affordable Care Act, but there does not seem to be immediate relief in sight. The most common plans have high annual out of pocket maximums that are not less than what people were paying pre-ACA,” said Dr. Zafar.

This study involved self-reported surveys and medical record data from patients diagnosed more than 9 years ago. The researchers used a path analysis to simultaneously estimate the associations between financial burden, disease status, quality of life, perceived quality of care, and other factors. There were 58 patients (6%) who had surrogates complete their surveys on their behalf because they were too sick to do it themselves.

The findings from this study suggest that oncologists need to integrate into their treatment discussions and decision-making the individual financial burden for each patient.  Igor Puzanov, MD, of Vanderbilt University in Nashville, TN, said financial toxicity can be avoided if more oncologists become more aware of the problem and become more proactive. 

“We have social workers, patient assistance coordinators, and pharmacists. When I see that a patient needs treatment with [a] drug, and all drugs I use in colorectal cancer and melanoma are more than $10,000 a month, I contact my nurse and pharmacist.  They order drug and precertify with certification drug specialists,” Dr. Puzanov told Cancer Therapy Advisor.   

He said with indigent patients there is usually a little more work involved but at his institution there is a staff in place to help patients and their families.  “It may be an issue of the cost of driving 3 hours one way, staying overnight, gas, etc.,” said Dr. Puzanov.  “If a patient cannot drive to see us because of financial burden, we get them someone closer to home and still try to keep the drugs covered.”