Patient-reported financial toxicity and adverse medical consequences in head and neck cancer

Beeler, Whitney H.; Bellile, Emily L.; Casper, Keith; Jaworski, E; Burger, N.; Malloy, Kelly M.; Spector, Matthew E.; Shuman, Andrew G.; Rosko, Andrew J.; Stucken, Chaz L.; Chinn, Steven B.; Dragovic, Aleksandar F.; Chapman, Christina H.; Owen, Dawn; Jolly, Shruti; Bradford, Carol R.; Prince, Mark; Worden, Francis P.; Jagsi, Reshma; Mierzwa, Michelle; Swiecicki, Paul

doi:10.1016/j.oraloncology.2019.104521

Cited by 51 publications

(99 citation statements)

References 43 publications

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“…We have previously shown that 33% of head and neck cancer patients going through radiation treatment reported at least a moderate financial burden from treatment, and this was associated with increased treatment non-compliance. 46 While 79% of participants in this study reported that financial issues were not a concern, possibly reflecting the relatively affluent population studied here, options that incorporate fewer in-person surveillance visits and more remote monitoring may help offset these patientborne burdens without compromising ability to detect recurrences.…”

Section: Discussionmentioning

confidence: 88%

“…treatment noncompliance [46]. Although 79% of participants in this study reported that financial issues were not a concern, possibly reflecting the relatively affluent population studied here, options that incorporate fewer in-person surveillance visits and more remote monitoring may help offset these patient-borne burdens without compromising ability to detect recurrences.…”

Section: Interest In Altered Surveillancementioning

confidence: 85%

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Patient Burden with Current Surveillance Paradigm and Factors Associated with Interest in Altered Surveillance for Early Stage HPV-Related Oropharyngeal Cancer

et al. 2021

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Introduction. Optimal surveillance paradigms for survivors of early stage human papillomavirus (HPV)-related oropharyngeal cancer are not well defined. This study aimed to characterize patient interest in and factors associated with an altered surveillance paradigm. Materials and Methods. We surveyed patients with Stage I or II HPV-related oropharyngeal cancer treated at a tertiary care institution from 2016 to 2019. Primary outcomes were descriptive assessment of patient knowledge, interest in altered surveillance, burdens of in-person appointments, and priorities for surveillance visits. Ordinal regression was used to identify correlates of interest in altered surveillance. Results. Sixty-seven patients completed surveys from February to April 2020 at a median of 21 months since completing definitive treatment. A majority (61%) of patients were interested in a surveillance approach that decreased in-person clinic visits. Patients who self-identified as medical maximizers, had higher worry of cancer recurrence, or were in long-term relationships were less likely to be interested. Patients reported significant burdens associated with surveillance visits, including driving distance, time off work, and non-medical costs. Patients were most concerned with discussing cancer recurrence (76%), physical quality of life (70%), mortality (61%), and mental quality of life (52%) with their providers at follow-up visits. Conclusions. Patients with early stage HPV-related oropharyngeal cancers are interested in altered surveillance approaches, experience significant burdens related to surveillance visits, and have concerns that are not well addressed with current surveillance approaches, including physical and mental quality of life. Optimized surveillance approaches should incorporate patient priorities and minimize associated burdens. The Oncologist 2021;9999:• • Implications for Practice: The number of patients with HPV-related oropharyngeal cancers is increasing, and numerous clinical trials are investigating novel approaches to treating these good-prognosis patients. There has been limited work assessing optimal surveillance paradigms in these patients. Patients experience significant appointment-related burdens, and have concerns such as physical and mental quality of life. Additionally, patients with early stage HPV-related oropharyngeal cancers express interest in altered surveillance approaches that decrease in-person clinic visits. Optimization of surveillance paradigms to promote broader survivorship care in clinical practice is needed.

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Section: Discussionmentioning

confidence: 88%

Section: Interest In Altered Surveillancementioning

confidence: 85%

Patient Burden with Current Surveillance Paradigm and Factors Associated with Interest in Altered Surveillance for Early Stage HPV-Related Oropharyngeal Cancer

et al. 2021

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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

Cancers

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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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“…Though cancer-related financial toxicity impacts patients across the spectrum of diseases, evidence suggests that there are particular aspects of financial toxicity that affect head and neck cancer patients, who make up an estimated 65 000 new cases annually in the United States and 550 000 annual cases worldwide. Only a small number of studies have focused solely on the financial hardship in head and cancer patients, but the limited evidence suggests that approximately one third of head and neck cancer patients report between moderate and catastrophic levels of financial hardship [ 14 , 15 ]. A deeper understanding of the sources of financial hardship in head and neck cancer patients is needed to design interventions and develop strategies to mitigate this problem.…”

Section: Introductionmentioning

confidence: 99%

Financial Toxicity in Head and Neck Cancer Patients Treated With Proton Therapy

Smith

Shih

Frank

2021

International Journal of Particle Therapy

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Cancer-related financial toxicity impacts head and neck cancer patients and survivors. With increasing use of proton therapy as a curative treatment for head and neck cancer, the multifaceted financial and economic implications of proton therapy—dimensions of “financial toxicity”—need to be addressed. Herein, we identify knowledge gaps and potential solutions related to the problem of financial toxicity. To date, while cost-effectiveness analysis has been used to assess the value of proton therapy for head and neck cancer, it may not fully incorporate empiric comparisons of patients' and survivors' lost productivity and disability after treatment. A cost-of-illness framework for evaluation could address this gap, thereby more comprehensively identifying the value of proton therapy and distinctly incorporating a measurable aspect of financial toxicity in evaluation. Overall, financial toxicity burdens remain understudied in head and neck cancer patients from a patient-centered perspective. Systematic, validated, and accurate measurement of financial toxicity in patients receiving proton therapy is needed, especially relative to conventional photon-based strategies. This will enrich the evidence base for optimal selection and rationale for payer coverage of available treatment options for head and neck cancer patients. In the setting of cancer care delivery, a combination of conducting proactive screening for financial toxicity in patients selected for proton therapy, initiating early financial navigation in vulnerable patients, engaging stakeholders, improving oncology provider team cost communication, expanding policies to promote price transparency, and expanding insurance coverage for proton therapy are critical practices to mitigate financial toxicity in head and neck cancer patients.

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Patient-reported financial toxicity and adverse medical consequences in head and neck cancer

Cited by 51 publications

References 43 publications

Patient Burden with Current Surveillance Paradigm and Factors Associated with Interest in Altered Surveillance for Early Stage HPV-Related Oropharyngeal Cancer

Patient Burden with Current Surveillance Paradigm and Factors Associated with Interest in Altered Surveillance for Early Stage HPV-Related Oropharyngeal Cancer

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

Financial Toxicity in Head and Neck Cancer Patients Treated With Proton Therapy

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