Emotional Distress and Financial Toxicity in Younger Adult Patients Undergoing Oncologic Surgery

Abstract

Background: There has been an alarming increase in the number of young adults (YA) diagnosed with cancer. The emotional, psychosocial, and financial distress experienced by newly diagnosed YA undergoing cancer surgery remains largely unknown. Methods: A validated biopsychosocial distress screening tool (SupportScreen) was administered to patients diagnosed with cancer before surgery between 2009 and 2017 in a National Cancer Institute Comprehensive Cancer Center. Patients were stratified into YA less than or equal to 45 years and older adults (OA) above 45 years. Descriptive statistics and logistic regression were used to analyze distress outcomes. Results: In total, 4297 patients were identified, with YA comprising 13.3% (n=573) of the cohort. YA reported higher emotional distress, including increased anxiety (33.8% vs 27.4%, P=0.002), greater fear of procedures (26.7% vs 22%, P=0.018), and difficulty managing emotions (26% vs 20.7%, P=0.006). YA struggled more frequently to manage work/school (29.5% vs 19.3%, P<0.001), finding resources (17.8% vs 11.8%, P<0.001), changes in physical appearance (22.2% vs 13.4%, P<0.001), fatigue (36% vs 27.3%, P<0.001), and ability to have children (18.4% vs 3%, P<0.001). Financial toxicity was significantly higher in the YA group (40.5% vs 28%, P<0.001). While income level was strongly protective against emotional distress and financial toxicity in OAs, it was less protective against the risk of financial toxicity in YA. Younger age was an independent predictor of financial toxicity in a model adjusted to income (odds ratio=1.52, P=0.020). Conclusions: YA in the prime of their personal and professional years of productivity require special attention when undergoing surgical evaluation for cancer. Resource allocation and counseling interventions should be integrated as part of their routine care to expedite their return to optimal physical and holistic health and mitigate psychosocial distress and financial toxicity.

Sex-related differences in oncologic outcomes, operative complications and health-related quality of life after curative-intent oesophageal cancer treatment: multicentre retrospective analysis

“…Female patients had higher rates of persistent gastrointestinal symptoms, while male patients presented better functional and overall HRQoL scores, resulting in a quicker return to everyday activity, but interestingly, also a higher risk of financial problems. Although caution is needed to not oversimplify a family model financially dependent on men’s income, we need to consider the risk of financial toxicity induced by OC and its management, especially in young patients 34 . These findings merit prospective assessment, allowing to incorporate within long-term follow-up the myriad nutritional, psychosocial and financial implications on OC and its therapy, and the differential challenges that sex and age may present.…”