Measuring Financial Distress and Quality of Life Over Time in Patients With Gynecologic Cancer—Making the Case to Screen Early in the Treatment Course

Abstract

PURPOSE: Our objective was to measure the trajectory of financial distress and to determine its relationship with quality of life (QOL) among patients with cancer. MATERIALS AND METHODS: We conducted a longitudinal survey of patients with gynecologic cancer starting a new line of systemic therapy at baseline, 3 months, and 6 months. Financial distress was measured using a Comprehensive Score for Financial Toxicity (COST) < 26, and QOL was measured using Functional Assessment of Cancer Therapy-General (FACT-G) with lower scores indicating worse responses. One-way repeated analysis of variances, generalized estimating equation models, and correlation coefficients were used to evaluate financial distress and QOL over time. RESULTS: There were 90 of 121 (74%) baseline participants with a 6-month follow-up. The average age was 60 years, 29% were African-American, 57% had an annual income < $40,000 in US dollars, and 6% were uninsured. At baseline, 54% of patients screened positive for financial distress, which was unchanged at 3 months (50%, P = .27) but decreased at 6 months (46%, P = .04) compared with baseline. There was no change in average COST (23.6, 25.1, 25.6; P = .33) or FACT-G (70.8, 71.0, 72.8; P = .68) over time. Less financial distress was moderately correlated with better QOL (r = 0.63, 0.61, 0.60) at each time point. The presence of financial distress was associated with a 16-point decrease in FACT-G QOL score over time. CONCLUSION: Upfront screening with COST identified 90% of patients who experienced financial distress, and COST did not change significantly over time. More severe financial distress was moderately correlated with worse QOL, and its presence was associated with a clinically meaningful 16-point decrease in QOL.

Greater financial toxicity relates to greater distress and worse quality of life among breast and gynecologic cancer survivors

“…The women in our study reported comparable financial toxicity levels as prior studies reporting COST scores of gynecologic cancer survivors averaging two years post‐diagnosis (median = 29) 9 and worse financial toxicity than survivors of solid tumors 2‐year post‐treatment ( M = 32.5, SD = 9.46, range = 6–44) 24 . Other studies have used COST scores <26 and ≤23 as cut‐off points and found 49%–54% of gynecologic cancer survivors reported financial distress 25,26 ; compared to 45% in our sample with scores <26 (i.e., aligned with mild, moderate, and severe financial toxicity based on the COST grading system).…”

Comprehensive Score for Financial Toxicity and Health-Related Quality of Life in Patients With Cancer and Survivors: A Systematic Review and Meta-Analysis

“…Interestingly, our included studies showed that the correlation strengths between financial toxicity and overall HRQOL were slightly stronger in studies that used English instruments (median = 0.53, range = 0.33-0.73) 57,58,60,62,64,66,73,81 than those in other languages, for example, Mandarin Chinese, Italian, and Arabic (median = 0.43, range = 0.34-0.52), 51,55,67,72,79,80 and conducted in countries with universal health coverage (median = 0.49, range = 0.34-0.73) 55,58,66,72,79,80 than those without (median = 0.42, range = 0.33-0.63). 51,57,60,62,64,67,73,81 Nevertheless, we had inadequate number of studies to further examine (eg, performing subgroup analysis) the potential impact of instrument language or universal health coverage on the association between financial toxicity and HRQOL. 46 Exploring the role of universal health coverage and mitigation strategies in alleviating financial toxicity and improving HRQOL may be an important future research direction.…”

Financial toxicity of patients with lung cancer in China: Results from a National Survey Study

“…1 An increasing amount of attention has been paid to FT in patients with cancer, in large part due to the rising costs of cancer diagnosis and treatment. 2 Previous studies of FT in cancer patients have examined the prevalence of FT among subgroups of patients with different cancer types, 3 , 4 , 5 , 6 cancer stages, 5 , 7 , 8 treatment schemes, 5 , 9 healthcare coverage systems, 10 , 11 , 12 or other subgroups as well as related factors of FT. These studies indicated disparities in prevalence and related factors among subgroups.…”