Association of significant financial burden with survival for head and neck cancer patients treated with radiation therapy

Jun, Sung; Iovoli, Austin J.; Attwood, Kristopher; Wooten, Kimberly; Arshad, Hassan; Gupta, Vishal; McSpadden, Ryan; Kuriakose, Moni Abraham; Markiewicz, Michael R.; Chan, Justin; Hicks, Wesley L.; Platek, Mary E.; Ray, Andrew D.; Repasky, Elizabeth A.; Farrugia, Mark

doi:10.1016/j.oraloncology.2021.105196

Cited by 28 publications

(48 citation statements)

References 39 publications

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“…Finally, in diseases that are predominantly managed in the outpatient setting such as chronic myelogenous leukemia (CML), drug prices for oral small-molecule inhibitors remain unsustainably high [ 11 , 12 ]. Understanding the prevalence of FT and its impact on outcomes represents an important step in devising future strategies for optimizing FT, as FT has been associated with poorer survival in other cancers [ 13 ].…”

Section: Introductionmentioning

confidence: 99%

Financial toxicity in hematological malignancies: a systematic review

et al. 2022

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Hematologic malignancy outcomes have remarkably improved in the past decade with further advancement expected in future years. However, the detrimental effects of financial toxicity (FT) on patients with hematologic malignancies, because of both diagnoses and subsequent treatments, have not been studied comprehensively. We performed a systematic review of all studies reporting FT as a primary or secondary outcome among adult or pediatric patients with hematological malignancies. A total of 55 studies met the inclusion criteria for analysis. Across studies, 20–50% of patients reported some form of FT, including loss of work productivity, food and transportation costs, and depletion of savings. Younger age, lower-income level, unemployment, and rural residence were the most commonly identified risk factors for FT. Two studies looked at survival outcomes, with one reporting improvement in survival with a decrease in financial toxicity. However, significant heterogeneity in FT definitions was found between countries and payor systems. Only half of the studies (51%, n = 28) used validated survey instruments such as the COST assessment. The present systematic review identified that FT is common in patients with hematological malignancies and may be associated with poorer outcomes. However, studies of FT generally use non-standardized methods with cross-sectional analyses rather than longitudinal, prospective assessments. Further work is needed to standardize FT reporting and investigate measures to alleviate FT among patients with hematologic malignancies.

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Section: Introductionmentioning

confidence: 99%

Financial toxicity in hematological malignancies: a systematic review

et al. 2022

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“…The prevalence of FT in their cohort was 14%, and it was significantly associated with younger age, distant metastasis at diagnosis, HPV‐negative tumor status, surgical treatment, and higher comorbidity burden 16 . They also found that patients with FT had significantly worse OS and CSS in both multivariable and matched analyses, although the absolute survival differences were not reported 16 . The differences between our findings and Ma et al may be due to limitations in our sample size, differences in patient populations, or differences in how FT was measured.…”

Section: Discussionmentioning

confidence: 98%

“…In the largest study available to date, Ma et al assessed FT in 284 patients with head and neck cancer treated with definitive or postoperative radiation therapy 16 . The prevalence of FT in their cohort was 14%, and it was significantly associated with younger age, distant metastasis at diagnosis, HPV‐negative tumor status, surgical treatment, and higher comorbidity burden 16 . They also found that patients with FT had significantly worse OS and CSS in both multivariable and matched analyses, although the absolute survival differences were not reported 16 .…”

Section: Discussionmentioning

confidence: 99%

Association of self‐reported financial burden with quality of life and oncologic outcomes in head and neck cancer

et al. 2021

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Background There is a paucity of data on financial toxicity among patients with head and neck squamous cell carcinoma (HNSCC). Materials This was a retrospective, cross‐sectional study of patients with HNSCC surveyed at an outpatient oncology clinic. Results The sample included 202 patients with HNSCC with a mean age of 59.6 years (SD 10.0). There were 53 patients (26%) with self‐reported financial burden. Education of high school or less was a significant predictor of self‐reported financial burden (OR 2.52, 95% CI 1.03–6.14, p = 0.042). Patients reporting financial burden had significantly worse physical (p = 0.003), mental (p = 0.003), and functional (p = 0.036) health‐related quality of life (HRQOL). Patients reporting financial burden appeared to have lower 5‐year overall survival (74.3% vs. 83.9%, p = 0.165), but this association did not reach statistical significance. Conclusion Financial burden or toxicity may affect approximately a quarter of patients with HNSCC and appears to be associated with worse HRQOL outcomes.

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“…FT is associated with the decline of QOL as well as increased mortality, possibly through a hesitancy to pursue additional treatment or non-compliance [ 9 , 10 , 11 , 21 , 22 , 23 ].…”

Section: Discussionmentioning

confidence: 99%

“…Head and neck cancer (HNC) patients are at particularly high risk for FT as they often require multi-modal therapy, have more out-of-pocket costs, have an increased reliance on cost-coping strategies, and are more likely to suffer production losses as a result of their disease and treatment [ 5 , 6 , 7 , 8 ]. Consequently, increased financial difficulties in HNC has been linked to impaired quality of life (QOL), increased missed appointments, reduced compliance with medications, and worse medical outcomes including survival [ 9 , 10 , 11 ]. Therefore, urgent mitigation strategies for FT among HNC patients are needed.…”

Section: Introductionmentioning

confidence: 99%

Financial Counseling Is Associated with Reduced Financial Difficulty Scores in Head and Neck Cancer Patients Treated with Radiation Therapy

Farrugia

Jun

et al. 2021

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Background: Financial toxicity (FT) can be devastating to cancer patients, and solutions are urgently needed. We investigated the impact of financial counseling (FC) on FT in head and neck cancer (HNC) patients. Methods: Via a single-institution database, we reviewed the charts of HNC patients who underwent definitive or post-operative radiotherapy, from October 2013 to December 2020. Of these patients, 387 had provided baseline and post-treatment information regarding financial difficulty. In July 2018, a dedicated financial counselor was provided for radiation therapy patients and we subsequently examined the impact of FC on financial difficulty scores. Results: Following the hiring of a dedicated financial counselor, there was a significant increase in the proportion of patients receiving FC (5.3% vs. 62.7%, p < 0.0001). Compared with baseline scores, patients who did not undergo FC had a significant increase in reported financial difficulty at the end of treatment (p = 0.002). On the other hand, there was no difference in pre- and post-treatment scores in patients who had received FC (p = 0.588). After adjusting for gender and nodal status with a multiple linear regression model, FC was significantly associated with change in financial difficulty (β = −0.204 ± 0.096, p = 0.035). On average, patients who received FC had a 0.2 units lower change in financial difficulty score as compared with those with the same gender and nodal stage but without FC. Conclusions: Providing a dedicated financial counselor significantly increased the proportion of HNC receiving FC, resulting in the stabilization of financial difficulty scores post-treatment. Based on a multiple linear regression model, FC was independently associated with reduced financial difficulty. The employment of a financial counselor may be a viable, hospital-based approach to begin to address FT in HNC.

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Association of significant financial burden with survival for head and neck cancer patients treated with radiation therapy

Cited by 28 publications

References 39 publications

Financial toxicity in hematological malignancies: a systematic review

Financial toxicity in hematological malignancies: a systematic review

Association of self‐reported financial burden with quality of life and oncologic outcomes in head and neck cancer

Financial Counseling Is Associated with Reduced Financial Difficulty Scores in Head and Neck Cancer Patients Treated with Radiation Therapy

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