Risk Factors for Financial Hardship in Patients Receiving Adjuvant Chemotherapy for Colon Cancer: A Population-Based Exploratory Analysis

Abstract

<jats:sec><jats:title>Purpose</jats:title><jats:p>Characteristics that predispose patients to financial hardship during cancer treatment are poorly understood. We therefore conducted a population-based exploratory analysis of potential factors associated with financial hardship and treatment nonadherence during and following adjuvant chemotherapy for colon cancer.</jats:p></jats:sec><jats:sec><jats:title>Patients and Methods</jats:title><jats:p>Patients diagnosed with stage III colon cancer between 2008 and 2010 were identified from a population-based cancer registry representing 13 counties in Washington state. Patients were asked to complete a comprehensive survey on treatment-related costs. Patients were considered to have experienced financial hardship if they accrued debt, sold or refinanced their home, borrowed money from friends or family, or experienced a 20% or greater decline in their annual income as a result of treatment-related expenses. Logistic regression analysis was used to investigate factors associated with financial hardship and treatment nonadherence.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>A total of 284 responses were obtained from 555 eligible patients (response rate, 51.2%). Nearly all patients in the final sample were insured during treatment. In this sample, 38% of patients reported one or more financial hardships as a result of treatment. The factors most closely associated with treatment-related financial hardship were younger age and lower annual household income. Younger age, lower income, and unemployment or disability (which occurred in most instances following diagnosis) were most closely associated with treatment nonadherence.</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>A significant proportion of patients undergoing adjuvant chemotherapy for stage III colon cancer may experience financial hardship, despite having health insurance coverage. Interventions to help at-risk patients early on during therapy may prevent long-term financial adverse effects.</jats:p></jats:sec>

Financial Burden of Cancer Clinical Trial Participation and the Impact of a Cancer Care Equity Program

“…Compared with non-CCEP participants, those enrolled in the CCEP were younger and had lower incomes. Studies have shown that, in general, younger patients and those with lower incomes experience considerable cancer-related financial problems [24,[48][49][50][51]. We also found that a higher proportion of CCEP participants were enrolled in phase I clinical trials and had metastatic disease.…”

The personal financial burden of complications after colorectal cancer surgery

“…Less than half of patients with stage III CRC discuss problems of treatment costs with their physicians. 9 Furthermore, previous studies have not evaluated the role that treatment complications may play in patients' susceptibility to economic hardship. Therefore, surgeons and other providers need to be particularly aware that patients with CRC who suffer treatmentrelated complications are at increased risk for economic hardship during treatment.…”

“…6,7 Beyond the clinical consequences, however, many patients with cancer also suffer significant economic hardship from their disease and its treatment. [8][9][10][11] Even among those with medical insurance, cancer therapies may require substantial out-of-pocket expenditures for medications, copayments for diagnostic testing, hospital and outpatient care, travel, and home care. [10][11][12][13] The financial impact of cancer can result in significant emotional and family stress and may impair overall quality of life.…”

Cost effectiveness in practice and its effect on clinical outcomes

“…The very high cost of these new targeted agents, however, means that high co-payments can effectively exclude access to the drug from large segments of the population. To the extent that even modest co-pays can lead to substantial out-of-pocket costs, several studies now suggest that financial distress and bankruptcy are increasingly common problems for cancer patients and their families [25][26][27].…”