Financial Hardship in Patients With Head and Neck Cancer

Abstract

PURPOSE: Financial hardship is a growing concern for patients with cancer. Patients with head and neck cancer (HNC) are particularly vulnerable, given that a third leave the workforce following treatment. The goal of our study was to characterize financial hardship in the psychologic response (response to increased expenses) and coping behaviors (behaviors patients adopt to manage their care in the setting of increased expenses) domains in patients with HNC compared with patients with other cancers. METHODS: This was a retrospective cohort study of nationally representative public survey data from 2013 to 2018 in the National Health Interviews Survey, an annual cross-sectional household survey. We included respondents age ≥ 18 years who reported a diagnosis of cancer and identified a subset of patients with HNC. Our main outcomes were financial hardship in the psychologic response and coping behaviors domains. RESULTS: Our sample included a weighted population of 357,052 patients with HNC and 21.4 million patients with other cancers. Compared with patients with other cancers, patients with HNC reported greater levels of coping behaviors hardship (31% v 23%, P = .015), but similar levels of psychologic financial hardship (73% v 72%, P = .787). Medicaid or uninsured patients more often reported coping behaviors hardship. On multivariable analysis, HNC (odds ratio, 1.51; 95% CI, 1.01 to 2.24) was independently associated with coping behaviors hardship. CONCLUSION: To our knowledge, this is the first study to evaluate financial hardship in patients with HNC compared with patients with other cancers that includes Medicaid and uninsured patients, who are more often to have financial hardship. Patients with HNC have greater levels of hardship in the coping behaviors domain compared with patients with other cancers, but similar levels in the psychologic response domain.

Financial toxicity among head and neck cancer patients and their caregivers: A cross‐sectional pilot study

“…Less than half (46%) of HNC patients agreed to participate in this study and provide information on the extent of financial toxicity they experienced. Compared to other financial toxicity studies among the HNC population, 9 , 10 , 12 , 13 , 14 , 39 , 40 we observed lower consent rates. This may be, in part, due to the ongoing coronavirus pandemic.…”

Measuring financial toxicity in head and neck cancer: a systematic review

“…Prospective or combined retrospective and prospective data collection was conducted in 6 cases 7 , 21 , 22 , 30 , 32 , 36 . Two retrospective studies were multicentric 18 , 23 , whereas six articles analysed financial data from national databases 19 , 20 , 25 , 27 , 28 , 33 .…”

Interventions for head and neck cancer survivors: Systematic review

“…We found health outcomes to address function and quality of life, rather than costs, health care utilization and mortality. Studies are needed that investigate and intervene on cost and financial toxicity, a recognized concern for HNC patients that are particularly vulnerable given the high rate of workforce exit 4 , 5 and gaps in dental coverage. 49 Due to the high prevalence of chronic medical conditions, subsequent cancers, smoking and other symptoms specific to HNC survivors, hospitalization and emergency‐department utilization, and mortality are needed.…”

“…Psychosocial effects are also significant, with HNC survivors experiencing high rates of depression and suicide, 3 fear of cancer recurrence, 3 and financial toxicity. [4][5][6][7] Both recurrence and subsequent malignancies are common, especially among HNC survivors with heavy alcohol and tobacco use. 8 Furthermore, HNC survivors may have pre-existing comorbidities that require ongoing medical management and health promotion to reduce risk.…”

“…Long‐term effects of HNC treatment are wide‐ranging and often serious, encompassing numerous physical conditions that are critical to daily functioning. Psychosocial effects are also significant, with HNC survivors experiencing high rates of depression and suicide, 3 fear of cancer recurrence, 3 and financial toxicity 4–7 . Both recurrence and subsequent malignancies are common, especially among HNC survivors with heavy alcohol and tobacco use 8 .…”