Opposing Trajectories of Cancer Outcomes and Financial Concerns

Effect of Finance Concerns

The investigators found that patients with head and neck cancer were especially at risk for having worsening quality of life as a result of financial toxicity. To explore this, they undertook an observational cohort study of patients with head and neck cancer who were treated with definitive or postoperative radiation therapy, often with chemotherapy as well.¹ The study comprised 284 patients with head and neck cancer, median age was 61 years, and 77 were men. Definitive radiation was given to 204 patients and 80 patients received adjuvant radiation; 237 patients received chemotherapy. Median follow up was 39.9 months.¹

The result of their study bore out their suspicions. Patient-reported baseline financial toxicity was significantly correlated with a decrease in overall and cancer-specific survival. In this study, 41 patients reported high financial toxicity at baseline. On multivariable analysis, these patients experienced worse overall survival (hazards ratio [HR] 1.75, 95% CI, 1.05-2.94; P =.03) and cancer-specific survival (HR 2.28, 95% CI, 1.31-3.96; P =.003). After match pair analysis of 66 patients, these correlations held for both overall survival (HR2.72, 95% CI, 1.04-7.09; P =.04) and cancer-specific survival (HR 3.75, 95% CI 1.22-11.5; P =.02).¹

“We looked at whether financial worry impacts survival. The answer was resoundingly ‘Yes’,” Dr Singh noted. “The association we found was very strong, and very concerning. If you’re worried about your finances, your risk of dying is roughly double.”⁴

Easing the Stress

Because the study showed that the patients’ perceived quality of life and the internal stresses they were experiencing were actually capable of affecting their treatment outcome, Dr Singh explained, “What we need to do is everything possible to maximize quality of life. That includes maximizing pain control and minimizing the worries [patients] have going into treatment, whether those worries are financial or otherwise.”⁴

Roswell has initiated financial counseling to lessen the fears that patients may have. Other measures that could potentially improve patient outcomes, such as sleep, are also being explored. How does sleep quality affect patients’ quality of life? How does it affect their response to treatment? Adverse effects of treatment?

“Nurses are well positioned to inquire about and understand patients’ worries and concerns,” Dr Singh noted (email communication, March 2021). Patients’ financial concerns are another aspect of overall well-being that should be considered. Patients who report financial concerns should be referred to both a social worker and a financial counselor.

The investigators noted that further research is warranted to investigate the impact of financial toxicity in head and neck cancer and mitigate its risk.

References

1. Ma SJ, Iovoli AJ, Attwood K, et al. Association of significant financial burden with survival for head and neck cancer patients treated with radiation therapy. Oral Oncol. Published online February 10, 2021. doi:10.1016/j.oraloncology.2021.105196
2. National Cancer Institute. Financial toxicity and cancer treatment (PDQ®) – health professional version. Updated September 18, 2019. Accessed April 1, 2021. https://www.cancer.gov/about-cancer/managing-care/track-care-costs/financial-toxicity-hp-pdq
3. Harris Poll. ASCO 2018 Cancer Opinions Survey. October 2018. Accessed April 1, 2021. https://www.asco.org/sites/new-www.asco.org/files/content-files/research-and-progress/documents/2018-NCOS-Results.pdf
4. Roswell Park Comprehensive Cancer Center. Cancer patients who are most worried about finances shown to have worse outcomes [news release]. Roswell Park. Published March 8, 2021. Accessed April 2, 2021. https://www.roswellpark.org/newsroom/202103-cancer-patients-who-are-most-worried-about-finances-shown-have-worse-outcomes-0