Financial distress in patients with advanced cancer

Barbaret, Cécile; Brosse, Christelle; Rhondali, Wadih; Ruer, Murielle; Monsarrat, Léa; Michaud, Patrick A.; Schott, Anne-Marie; Delgado-Guay, Marvin Omar; Bruera, Éduardo; Sanchez, Stéphane; Filbet, Marilène

doi:10.1371/journal.pone.0176470

Cited by 49 publications

(67 citation statements)

References 28 publications

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“…According to our study, young CRC patients are especially at risk of income loss. Other studies also identified younger age as a factor associated with cancer-related financial problems [27][28][29][30]. Cancer treatment may interrupt employment and have a lasting negative impact on earnings and career development.…”

Section: Discussionmentioning

confidence: 99%

The patient-level effect of the cost of Cancer care – financial burden in German Cancer patients

et al. 2020

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Background: Financial toxicity of cancer has so far been discussed primarily in the US health care system and is associated with higher morbidity and mortality. In European health care systems, the socioeconomic impact of cancer is poorly understood. This study investigates the financial burden and patient-reported outcomes of neuroendocrine (NET) or colorectal (CRC) cancer patients at a German Comprehensive Cancer Center. Methods: This prospective cross-sectional study surveyed 247 advanced stage patients (n = 122 NET/n = 125 CRC) at the National Center for Tumor Diseases, in Germany about cancer-related out-of-pocket costs, income loss, distress, and quality of life. Multiple linear regression analysis was performed to demonstrate the effects of economic deterioration on patients' quality of life and distress. Results: 81% (n = 199) of the patients reported out-of-pocket costs, and 37% (n = 92) income loss as a consequence of their disease. While monthly out-of-pocket costs did not exceed 200€ in 77% of affected patients, 24% of those with income losses reported losing more than 1.200€ per month. High financial loss relative to income was significantly associated with patients' reporting a worse quality of life (p < .05) and more distress (p < .05). Conclusions: Financial toxicity in third-party payer health care systems like Germany is caused rather by income loss than by co-payments. Distress and reduced quality of life due to financial problems seem to amplify the burden that already results from a cancer diagnosis and treatment. If confirmed at a broader scale, there is a need for targeted support measures at the individual and system level.

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Section: Discussionmentioning

confidence: 99%

The patient-level effect of the cost of Cancer care – financial burden in German Cancer patients

et al. 2020

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“…Our two previous studies , separate primary analyses of the FD data for the same patients from the U.S. and France, were the first to evaluate the impact of FD on overall suffering of patients with advanced cancer and analyze the reasons for FD in the U.S. and French health care systems. The French patients’ lower rate of FD (and higher rate of cancer treatment) are not surprising considering that the costs of cancer treatment are 100% covered by the French health care system.…”

Section: Discussionmentioning

confidence: 99%

“…The impact on personal finances and the contribution of financial distress (FD) to overall QOL are some of most important and least explored effects of cancer. Recent studies in the U.S. and in France showed associations between patients’ FD, QOL, and symptom distress. Kendall et al reported that financial difficulties were a significant and frequent source of distress among patients undergoing care at a community cancer center in the U.S. .…”

Section: Introductionmentioning

confidence: 99%

Inequalities in Financial Distress, Symptoms, and Quality of Life Among Patients with Advanced Cancer in France and the U.S.

Barbaret

Delgado-Guay

Sanchez³

et al. 2019

The Oncologist

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Background Financial distress (FD) is common among patients with advanced cancer. Our purpose was to compare the frequency and intensity of FD and its associations with symptom distress and quality of life (QOL) in these patients in France and the U.S. Materials and Methods In this secondary analysis of two cross‐sectional studies, we assessed data on 292 patients who received cancer care at a public hospital or a comprehensive cancer center in France (143 patients) or the U.S. (149 patients). Outpatients and hospitalized patients over 18 years of age with advanced lung or breast or colorectal or prostate cancer were included. Diagnosed cognitive disorder was considered a noninclusion criterion. Advanced cancer included relapse or metastasis or locally advanced cancer or at least a second‐line chemotherapy regimen. Patients self‐rated FD and assessed symptoms, psychosocial distress, and QOL on validated questionnaires. Results The average patient age was 59 years, and 144 (49%) were female. FD and high intensity were reported more frequently in U.S. patients than in French (respectively 129 [88%] vs. 74 [52%], p < .001; 100 [98%] vs. 48 [34%], p < .001,). QOL was rated higher by the U.S. patients than by the French (69 [SD, 18] vs. 63 [SD, 18], p = .003). French patients had more psychological symptoms such as anxiety (8 [SD, 4] vs. 6 [SD, 5], p = .008). Associations were found between FD and U.S. residence, FD and single status (0.907, p = .023), and FD and metastasis (1.538, p = .036). In contrast, negative associations were found between FD and older age (−0.052, p = .003) and FD and France residence (−3.376, p = .001). Conclusion Regardless of health care system, FD is frequent in patients with advanced cancer. U.S. patients were more likely to have FD than French patients but reported better QOL. Further research should focus on factors contributing to FD and opportunities for remediation. Implications for Practice Suffering is experienced in any component of the lives of patients with a life‐threatening illness. Financial distress (FD) is one of the least explored cancer‐related symptoms, and there are limited studies describing its impact on this frail population. This study highlights the high frequency and severity of FD in patients with advanced cancer in the U.S. and France as well as its impact on their physical and emotional symptoms and their quality of life in these different health care systems. It is necessary for all health care providers to explore and evaluate the presence of FD in patients living with life‐threatening illnesses.

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“…Financial burden A relatively objective measure of personal financial status, defined as the ratio of total out-of-pocket spending on health-related costs (medical and nonmedical expenses) to total household income [68][69][70][71] Financial distress A subjective measure of the impact of financial burden on patient well-being; captures the affective experience and reflects the extent of worry, anxiety, or anguish about financial burden, experienced or anticipated 72,73 Financial hardship Difficulty one might experience in attempting to secure financial resources; can be expressed in domains such as finances, health, and food (eg, difficulty paying bills, ongoing financial stress, medication reduction to reduce cost, food insecurity) 1,36 Financial toxicity The adverse economic consequences to patients resulting from treatments and disease; conveys the harmful personal financial burden faced by patients receiving cancer treatment. Implicit is the notion that financial toxicity may be reduced through informed decision making about tests, procedures, and therapies that align with patients' priorities and financial resources.…”

Section: Terms Definitions Referencesmentioning

confidence: 99%

Understanding, measuring, and addressing the financial impact of cancer on adolescents and young adults

Salsman

Bingen

Barr

et al. 2019

Pediatric Blood & Cancer

109

123

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The financial impact of cancer treatment among adolescents and young adults (AYAs, 15–39 years) is deep and long lasting. Compared with other age groups, because of their life stage, AYAs are particularly vulnerable to the adverse economic effects of cancer treatment, also known as financial toxicity. Clinical manifestations of cancer‐related financial toxicity include interrupted work and income loss, accumulated debt, treatment nonadherence, avoidance of medical care, and social isolation. Effective clinical interventions should include efforts to increase financial self‐efficacy as well as direct support. Measures that are valid, reliable, multidimensional, and age‐appropriate are needed to study and address financial toxicity in the AYA population.

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Financial distress in patients with advanced cancer

Cited by 49 publications

References 28 publications

The patient-level effect of the cost of Cancer care – financial burden in German Cancer patients

The patient-level effect of the cost of Cancer care – financial burden in German Cancer patients

Inequalities in Financial Distress, Symptoms, and Quality of Life Among Patients with Advanced Cancer in France and the U.S.

Understanding, measuring, and addressing the financial impact of cancer on adolescents and young adults

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