The impact of financial toxicity in gastrointestinal cancer patients

Christopher J. LaRocca, Arthur Li, Kelly Lafaro, Karen Clark, Matthew Loscalzo, Laleh G. Melstrom, Susanne G. Warner

Research output: Contribution to journalArticlepeer-review

11 Scopus citations


BACKGROUND: Biopsychosocial distress screening is a critical component of comprehensive cancer care. Financial issues are a common source of distress in this patient population. This study uses a biopsychosocial distress screening tool to determine the factors associated with financial toxicity and the impact of these stressors on gastrointestinal cancer patients.

METHODS: A 48-question, proprietary distress screening tool was administered to patients with gastrointestinal malignancies from 2009 to 2015. This validated, electronically-administered tool is given to all new patients. Responses were recorded on a 5-point Likert scale from 1 (not a problem) to 5 (very severe problem), with responses rated at ≥3 indicative of distress. Univariate and multivariate logistic regressions were used to analyze the data.

RESULTS: Most of the 1,027 patients had colorectal (50%) or hepatobiliary (31%) malignancies. Additionally, 34% of all patients expressed a high level of financial toxicity. Age greater than 65 (odds ratio: 0.63, 95% confidence interval: 0.47-0.86, P < .01), college education (odds ratio: 0.53, 95% confidence interval: 0.38-0.73, P < .0001), being partnered (odds ratio: 0.61, 95% confidence interval: 0.44-0.84, P < .01), and annual income greater than $40,000 (odds ratio: 0.27, 95% confidence interval: 0.19-0.38, P < .0001) were all protective against financial toxicity on univariate analysis. Also, heavy tobacco use was associated significantly with increased distress on univariate analysis (odds ratio: 2.79, 95% confidence interval: 1.38-5.78, P < .01). With the exception of partnered status (odds ratio: 1.18, 95% confidence interval: 0.76-1.85, P = .46), all these variables retained their significant association with financial toxicity in the multivariate model.

CONCLUSION: Financial toxicity impacts a large number of cancer patients. Further study of at-risk populations may identify patients who would benefit from pre-emptive education and counseling interventions as part of their routine cancer care.

Original languageEnglish (US)
Pages (from-to)167-172
Number of pages6
JournalSurgery (United States)
Issue number1
StatePublished - Jul 2020

Bibliographical note

Funding Information:
Dr. Warner is supported by a mentored scholar research grant from the American Cancer Society (SGW: MRSG-16–047–01-MPC). Dr. Warner is also grateful for the generosity of Natalie Roberts.

Publisher Copyright:
© 2020 Elsevier Inc.


  • Aged
  • Female
  • Gastrointestinal Neoplasms/economics
  • Humans
  • Income
  • Male
  • Middle Aged
  • Poverty/psychology
  • Stress, Psychological/economics
  • Surveys and Questionnaires

PubMed: MeSH publication types

  • Research Support, Non-U.S. Gov't
  • Journal Article


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