TY - JOUR
T1 - Patient-reported financial toxicity, quality of life, and health behaviors in insured US cancer survivors
AU - Ver Hoeve, Elizabeth S.
AU - Ali-Akbarian, Leila
AU - Price, Sarah N.
AU - Lothfi, Nurhyikmah M.
AU - Hamann, Heidi A.
N1 - Funding Information:
Research reported in this publication was supported by a grant from the Merck Foundation Alliance to Advance Patient-Centered Cancer Care awarded to Heidi Hamann, PhD. Acknowledgments
Funding Information:
We wish to thank all study participants for their valuable contributions. Research reported in this publication utilized the Behavioral Measurement and Interventions Shared Resource (BMISR) which is supported by the National Cancer Institute of the National Institutes of Health under award number P30 CA023074.
Publisher Copyright:
© 2020, Springer-Verlag GmbH Germany, part of Springer Nature.
PY - 2021/1
Y1 - 2021/1
N2 - Purpose: Fighting cancer is a costly battle, and understanding the relationship between patient-reported financial toxicity (FT) and health outcomes can help inform interventions for post-treatment cancer survivors. Methods: Stages I–III solid tumor, insured US cancer survivors (N = 103) completed a survey addressing FT (as measured by the standardized COST measure) and clinically relevant health outcomes (including health-related quality of life [HRQOL] and adherence to recommended survivorship health behaviors). Univariate and multivariate analyses were used to assess demographic and disease-specific correlates of FT, and to assess the predictive value of FT on HRQOL and adherence to survivorship health behaviors. Results: Approximately 18% of respondents noted FT levels associated with significant financial burden. In univariate analyses, after correcting for multiple comparisons, greater FT was associated with unpartnered status, non-retirement, and lower level of educational attainment. Greater FT was also significantly associated with HRQOL components of anxiety, fatigue, pain, physical functioning, and social functioning. FT was not significantly associated with any measured survivorship health behaviors. In multivariate analyses, FT was found to be a meaningful predictor of patient-reported anxiety, fatigue, physical functioning, and social functioning above and beyond theoretically and statistically relevant demographic characteristics. Conclusions: Although overall levels of FT were lower among cancer survivors in this sample, as compared with active treatment patients assessed in previous studies, financial burden continued to be a concern for a significant minority of cancer survivors and was associated with components of reduced HRQOL. Further research is needed to understand FT among underinsured survivors and those treated in community oncology settings. Implications for cancer survivors: Incorporation of FT assessment into survivorship care planning could enhance clinical assessment of survivors’ FT vulnerability, help address the dynamic and persistent challenges of survivorship, and help identify those most in need of intervention across the cancer care continuum.
AB - Purpose: Fighting cancer is a costly battle, and understanding the relationship between patient-reported financial toxicity (FT) and health outcomes can help inform interventions for post-treatment cancer survivors. Methods: Stages I–III solid tumor, insured US cancer survivors (N = 103) completed a survey addressing FT (as measured by the standardized COST measure) and clinically relevant health outcomes (including health-related quality of life [HRQOL] and adherence to recommended survivorship health behaviors). Univariate and multivariate analyses were used to assess demographic and disease-specific correlates of FT, and to assess the predictive value of FT on HRQOL and adherence to survivorship health behaviors. Results: Approximately 18% of respondents noted FT levels associated with significant financial burden. In univariate analyses, after correcting for multiple comparisons, greater FT was associated with unpartnered status, non-retirement, and lower level of educational attainment. Greater FT was also significantly associated with HRQOL components of anxiety, fatigue, pain, physical functioning, and social functioning. FT was not significantly associated with any measured survivorship health behaviors. In multivariate analyses, FT was found to be a meaningful predictor of patient-reported anxiety, fatigue, physical functioning, and social functioning above and beyond theoretically and statistically relevant demographic characteristics. Conclusions: Although overall levels of FT were lower among cancer survivors in this sample, as compared with active treatment patients assessed in previous studies, financial burden continued to be a concern for a significant minority of cancer survivors and was associated with components of reduced HRQOL. Further research is needed to understand FT among underinsured survivors and those treated in community oncology settings. Implications for cancer survivors: Incorporation of FT assessment into survivorship care planning could enhance clinical assessment of survivors’ FT vulnerability, help address the dynamic and persistent challenges of survivorship, and help identify those most in need of intervention across the cancer care continuum.
KW - Cancer
KW - Financial toxicity
KW - Health-related quality of life
KW - Patient-reported outcomes
KW - Survivor
KW - Survivorship health behaviors
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U2 - 10.1007/s00520-020-05468-z
DO - 10.1007/s00520-020-05468-z
M3 - Article
C2 - 32361832
AN - SCOPUS:85085084476
SN - 0941-4355
VL - 29
SP - 349
EP - 358
JO - Supportive Care in Cancer
JF - Supportive Care in Cancer
IS - 1
ER -