Sensitivity of Psychosocial Distress Screening to Identify Cancer Patients at Risk for Financial Hardship During Care Delivery

Abstract

PURPOSE: Patients with cancer frequently encounter financial hardship, yet systematic strategies to identify at-risk patients are not established in care delivery. We assessed sensitivity of distress-based screening to identify patients with cancer-related financial hardship and associated care delivery outcomes. METHODS: A survey of 225 patients at a large cancer center assessed cancer-related financial hardship (0-10 Likert scale; highest quintile scores ≥ 5 defined severe hardship). Responses were linked to electronic medical records identifying patients’ distress screening scores 6 months presurvey (0-10 scale) and outcomes of missed cancer care visits and bad debt charges (unrecovered patient charges) within 6 months postsurvey. A positive screen for distress was defined as score ≥ 4. We analyzed screening test characteristics for identifying severe financial hardship within 6 months and associations between financial hardship and outcomes using logistic models. RESULTS: Although patients with positive distress screens were more likely to report financial hardship (odds ratio [OR], 1.21; 1.08-1.37; P < .001), a positive distress screen was only 48% sensitive and 70% specific for identifying severe financial hardship. Patients with worse financial hardship scores were more likely to miss oncology care visits within 6 months (for every additional point in financial hardship score from 0 to 10, OR, 1.28; 1.12-1.47; P < .001). Of patients with severe hardship, 72% missed oncology visits versus 35% without severe hardship ( P = .006). Patients with worse hardship were more likely to incur any bad debt charges within 6 months (OR, 1.32; 1.13-1.54; P < .001). CONCLUSION: Systematic financial hardship screening is needed to help mitigate adverse care delivery outcomes. Existing distress-based screening lacks sensitivity.

Financial toxicity impact on younger versus older adults with cancer in the setting of care delivery

“…The score for overall FT and subscore FT ranged from 0 to 10 (least to most severe FT burden). In analyses, this was tested as a continuous variable as well as a dichotomous variable categorized as “severe” (score ≥5) versus “not severe” (score <5), based on a scoring threshold identified in a prior study associated with adverse care delivery outcomes 12 …”

“…Early in the cancer care/survivorship trajectory—during treatment and early follow‐up—is a phase in care when patients have high health care utilization (and expenses) and interact closely and frequently with providers. This is also a phase when early FT intervention may minimize downstream adverse effects of FT, such as accumulation of medical debt and nonadherence to curative cancer care 7,10,12 . Accordingly, in this survey study, we sought to quantify and compare the domains and severity of the material, coping, and psychological FT burdens early in the care and survivorship trajectory for working‐age adults (including YA 18‐39 years old and other working‐age adults 40‐64 years old) and older adults with cancer.…”

Navigating financial toxicity in patients with cancer: A multidisciplinary management approach

“…Analogously, routine assessment and re‐assessment of FT concerns is needed, and novel developments toward implementing automated software systems and technological solutions to support the assessment of patient‐reported outcomes may support its implementation. When providers identify unaddressed FT in their patients in clinical care, ad‐hoc referral to social work and financial navigation is needed for expeditious and tailored FT management 45 …”

“…A spectrum of adverse health‐related outcomes is also associated with FT. Individuals with more severe FT have decreased quality of life, more anxiety and depression, and lower adherence to prescription medication and oncology care 45,88‐92 . Evidence further suggests that individuals with severe FT encounter higher all‐cause mortality risks 93,94 .…”

Rationale and design of Children’s Oncology Group (COG) study ACCL20N1CD: financial distress during treatment of acute lymphoblastic leukemia in the United States

“…Research personnel at each COG NCORP institution that enrolls at least one parent in this study will complete an annual survey about institution-level factors that may be associated with implementation of the recommendation for regular systematic financial distress screening of childhood cancer populations [ 29 , 45 ]. The institutional survey includes items that ask about the availability of resources (social workers, financial advisors, navigators) for patients receiving care at the institution and their families.…”