TOPLINE:

A longitudinal survey found that financial toxicity affected 80% of patients with cancer at baseline and decreased modestly over 6 months. Higher financial toxicity was consistently associated with lower health-related quality of life (HRQOL) and increased psychological distress, with patients who sought but did not receive financial counseling experiencing the greatest toxicity.

METHODOLOGY:

• Financial toxicity fluctuates over time in patients with cancer and is known to be associated with lower HRQOL and greater psychological distress; however, previous research used nonvalidated scales, inconsistently assessed key variables, and focused on single cancer types. Rigorous longitudinal studies using validated measures across diverse cancer types are lacking.
• Researchers conducted a longitudinal survey study of 732 adults with cancer (mean age, 67.6 years; 89% White individuals; 82% with Medicare), recruiting patients treated at the University of Chicago, Chicago, via clinic visits or social worker referral and those seeking out‐of‐pocket medication assistance through the Patient Access Network Foundation.
• Participants completed validated surveys assessing financial toxicity, HRQOL, and psychological distress at enrollment and follow-up intervals. Financial toxicity was assessed using the 11-item Comprehensive Score for Financial Toxicity (COST), HRQOL using the Functional Assessment of Cancer Therapy-General, and psychological distress using the Brief Profile of Mood States.
• Financial toxicity was categorized using validated COST cutoffs: grade 0 (no toxicity) for scores ≥ 26, grade 1 (mild) for scores 14-25, grade 2 (moderate) for scores 1-13, and grade 3 (severe) for a score of 0. Multilevel ordinal logistic and linear regression models were used to assess longitudinal relationships between financial toxicity, HRQOL, and psychological distress.
• The most common cancers were multiple myeloma (26%), prostate cancer (16%), and non-Hodgkin lymphoma (12%). Among patients with known staging, all stages (I-IV) were represented, with stage IV being most frequent (32%). Participation rates were 66% at 1 month, 58% at 3 months, and 52% at 6 months, with 39% completing all four surveys.

TAKEAWAY:

• At enrollment, the mean COST was 17.9 (corresponding to grade 1 financial toxicity). The probability of any financial toxicity declined from 79% at enrollment to 72% at 1 month and stabilized at 68% at 3 and 6 months.
• After adjustment for demographic and clinical factors, unemployment or disability (vs retirement, adjusted odds ratio [aOR], 3.58), out-of-pocket cancer expenses (aOR, 1.97), income loss (aOR, 3.40 for 1%-50% and 6.09 for 51%-100%), and limited health literacy (aOR, 1.64) were associated with greater financial toxicity, whereas having a college degree was significantly associated with lower financial toxicity (aOR, 0.45).
• In unadjusted analyses, prior intravenous chemotherapy was associated with higher odds of financial toxicity (OR, 1.58), and current intravenous chemotherapy was associated with even greater odds (OR, 1.73). No significant associations were observed for radiotherapy, oral targeted therapy, immunotherapy, or hormonal therapy.
• Patients who wished for but did not access a financial counselor had 5.67-fold higher odds of financial toxicity (aOR, 5.67), whereas those who did not need one had lower odds (aOR, 0.26). Similarly, wishing for help with paying for care was linked to higher odds of financial toxicity (aOR, 8.49).
• In multilevel linear regression models accounting for longitudinal survey responses and adjusting for sociodemographic factors, higher financial toxicity was significantly associated with both lower HRQOL and greater psychological distress.

IN PRACTICE:

“Adequate screening and interventions for FT [financial toxicity] are paramount to ensure improved physical and emotional health for patients with cancer,” the authors wrote. 
“Future studies intervening on FT in real time during cancer treatments could improve HRQOL and reduce psychological distress. We must reduce FT to prevent its downstream effects such as bankruptcy while patients are trying to survive cancer,” they concluded.

SOURCE:

The study, led by Austin Wesevich, MD, MPH, MS, University of Chicago, was published online in JCO Oncology Practice.

LIMITATIONS:

Participants were mostly White individuals and from less vulnerable ZIP codes, potentially underestimating financial toxicity in diverse populations. Data predated the approval of expensive immunotherapies. Predominant multiple myeloma cases enriched hematologic malignancies, reducing generalizability to other cancer types.

DISCLOSURES:

The study received funding support through grants from National Institutes of Health (NIH) National Cancer Institute and NIH Clinical and Translational Science Awards program. One author reported being employed at the University of Chicago and Rush University, leadership in a radiation oncology collaborative study group, and research funding from Radiological Society of North America and the American Association for Cancer Education. Another author reported having leadership roles with The Joint Commission and Costs of Care. No other conflicts of interest were reported.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.