Divergent Patterns in Care Utilization and Financial Distress between Patients with Blood Cancers and Solid Tumors: A National Health Interview Survey Study, 2014–2020

Abstract

Introduction: Important differences exist between the presentation, treatment, and survivorship of patients and survivors with blood cancers. Furthermore, existing research in financial toxicity has not fully addressed the relationship between medical care utilization and patient-reported outcomes of financial barriers and distress. We answered these questions by using a nationally representative survey. Methods: Respondents with blood cancers and solid tumors from the National Health Interview Survey were identified (2014–2020). We identified 23 survey questions as study outcomes and grouped them into three domains of medical care utilization, financial barriers to care, and financial distress. Associations between the three domains and associations of study outcomes between cancer types were examined using weighted univariate analyses and multivariable linear and logistic regressions. Results: The final study group consisted of 6248 respondents with solid tumors and 398 with blood cancers (diagnosed ≤ 5 years). Across all respondents with cancer, higher medical care utilization is generally associated with increased financial barriers to care. Compared to respondents with solid tumors, respondents with blood cancers had a higher level of medical care utilization (β = 0.36, p = 0.02), a lower level of financial barriers to care (β = −0.19, p < 0.0001), and a higher level of financial distress in affording care (β = 0.64, p = 0.03). Conclusions: Patients and survivors with blood cancers and solid tumors demonstrate divergent patterns in care utilization, financial barriers, and financial distress. Future research and interventions on financial toxicity should be tailored for individual cancer groups, recognizing the differences in medical care utilization, which affect the experienced financial barriers.

Financial Toxicity and Health-Related Quality of Life Profile of Patients With Hematologic Malignancies Treated in a Universal Health Care System

“…15,16 Regardless of the health care system, 17,18 it has been observed that patients with hematologic cancers have higher level of medical care utilization and financial hardship in affording care compared with patients with solid tumors. 19 This may be due to frequent need for blood and platelet transfusion support requiring visits to the clinic, the high prevalence of fatigue that may limit the capacity to work, or the long periods of hospitalization to recover from intensive chemotherapy. 20 Because of these differences, dedicated analyses and interventions on FT experienced by patients with hematologic malignancies are necessary.…”

Financial Toxicity Interventions in Hematologic Malignancies Are Timely and Necessary

“…6,7 Although clinicians recognize fundamental differences between the treatment landscape of solid tumors and hematologic malignancies-for instance, radiation and surgery as options for solid tumors versus months long inpatient admissions for leukemia induction chemotherapy-there are other distinct differences in health care utilization and end-of-life care. Despite accounting for only about 10% of all patients with cancer, 8 patients with hematologic malignancies demonstrate different care utilization patterns 9,10 and use more aggressive medical care and less hospice services at the end of life compared with patients with solid tumors. 11,12 Therefore, dedicated interventions targeted at alleviating the financial burden experienced by patients with hematologic malignancies are timely and necessary.…”