Financial Toxicity and Its Association With Health-Related Quality of Life Among Partners of Colorectal Cancer Survivors

Abstract

ImportancePartners of colorectal cancer (CRC) survivors play a critical role in diagnosis, treatment, and survivorship. While financial toxicity (FT) is well documented among patients with CRC, little is known about long-term FT and its association with health-related quality of life (HRQoL) among their partners.ObjectiveTo understand long-term FT and its association with HRQoL among partners of CRC survivors.Design, Setting, and ParticipantsThis survey study incorporating a mixed-methods design consisted of a mailed dyadic survey with closed- and open-ended responses. In 2019 and 2020, we surveyed survivors who were 1 to 5 years from a stage III CRC diagnosis and included a separate survey for their partners. Patients were recruited from a rural community oncology practice in Montana, an academic cancer center in Michigan, and the Georgia Cancer Registry. Data analysis was performed from February 2022 to January 2023.ExposuresThree components of FT, including financial burden, debt, and financial worry.Main Outcomes and MeasuresFinancial burden was assessed with the Personal Financial Burden scale, whereas debt and financial worry were each assessed with a single survey item. We measured HRQoL using the PROMIS-29+2 Profile, version 2.1. We used multivariable regression analysis to assess associations of FT with individual domains of HRQoL. We used thematic analysis to explore partner perspectives on FT, and we merged quantitative and qualitative findings to explain the association between FT and HRQoL.ResultsOf the 986 patients eligible for this study, 501 (50.8%) returned surveys. A total of 428 patients (85.4%) reported having a partner, and 311 partners (72.6%) returned surveys. Four partner surveys were returned without a corresponding patient survey, resulting in a total of 307 patient-partner dyads for this analysis. Among the 307 partners, 166 (56.1%) were aged younger than 65 years (mean [SD] age, 63.7 [11.1] years), 189 (62.6%) were women, and 263 (85.7%) were White. Most partners (209 [68.1%]) reported adverse financial outcomes. High financial burden was associated with worse HRQoL in the pain interference domain (mean [SE] score, −0.08 [0.04]; P = .03). Debt was associated with worse HRQoL in the sleep disturbance domain (−0.32 [0.15]; P = .03). High financial worry was associated with worse HRQoL in the social functioning (mean [SE] score, −0.37 [0.13]; P = .005), fatigue (−0.33 [0.15]; P = .03), and pain interference (−0.33 [0.14]; P = .02) domains. Qualitative findings revealed that in addition to systems-level factors, individual-level behavioral factors were associated with partner financial outcomes and HRQoL.Conclusions and RelevanceThis survey study found that partners of CRC survivors experienced long-term FT that was associated with worse HRQoL. Multilevel interventions for both patients and partners are needed to address factors at individual and systemic levels and incorporate behavioral approaches.

Validation of the COmprehensive Score for Financial Toxicity (COST) in Vietnamese patients with cancer

“…The significant positive correlation between the COST and HRQoL measured using the EQ-5D or EQ VAS supports the convergent validity of the COST. This finding provides evidence that patients with higher COST scores experience higher HRQoL; consequently, a higher level of FT is associated with worse HRQoL, which is consistent with previous studies [ 7 , 30 , 31 ]. In addition, factors such as low socioeconomic status and cancer treatment bolster evidence for the multidimensionality of the FT [ 6 , 32 ] and the validity of the COST for application across diverse clinical characteristics and settings [ 7 ].…”

Cancer diagnosis and treatment in working‐age adults: Implications for employment, health insurance coverage, and financial hardship in the United States

“…Spouses of survivors with cancer-related health problems, medical events, or disabilities are more likely to experience worse mental and physical health-related quality of life than their counterparts whose spouses do not have cancer-related health problems. 74,75 The burden of informal caregiving falls disproportionately on women; among employed spouses, women whose spouses were receiving cancer treatment were more likely to take time off work to provide care and took more days off. 76 In addition, parental cancer history is associated with worse physical and mental health for their dependent children and more sick days missed from school.…”

“…If they work for small employers who have fewer than 50 employees, they do not have options for job‐protected unpaid leave under the FMLA. Spouses of survivors with cancer‐related health problems, medical events, or disabilities are more likely to experience worse mental and physical health‐related quality of life than their counterparts whose spouses do not have cancer‐related health problems 74,75 . The burden of informal caregiving falls disproportionately on women; among employed spouses, women whose spouses were receiving cancer treatment were more likely to take time off work to provide care and took more days off 76 .…”

Hit it hard: qualitative patient perspectives on the optimisation of immune checkpoint inhibition

“…Treatment with ICI is placing an increasing financial burden on patients and healthcare services worldwide, with annual costs of these treatments expected to grow from $24 billion in 2022 to $46 billion in 2026 [9]. For individual patients, the financial implications of treatment are associated with poor HRQoL [10][11][12].…”