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

doi:10.1016/j.surg.2020.02.006

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 journal › Article › peer-review

16 Scopus citations

Abstract

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 language	English (US)
Pages (from-to)	167-172
Number of pages	6
Journal	Surgery (United States)
Volume	168
Issue number	1
DOIs	https://doi.org/10.1016/j.surg.2020.02.006
State	Published - 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.

Keywords

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

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1016/j.surg.2020.02.006

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title = "The impact of financial toxicity in gastrointestinal cancer patients",

abstract = "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.",

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

author = "LaRocca, {Christopher J.} and Arthur Li and Kelly Lafaro and Karen Clark and Matthew Loscalzo and Melstrom, {Laleh G.} and Warner, {Susanne G.}",

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: {\textcopyright} 2020 Elsevier Inc.",

year = "2020",

month = jul,

doi = "10.1016/j.surg.2020.02.006",

language = "English (US)",

volume = "168",

pages = "167--172",

journal = "Surgery (United States)",

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AU - LaRocca, Christopher J.

AU - Li, Arthur

AU - Lafaro, Kelly

AU - Clark, Karen

AU - Loscalzo, Matthew

AU - Melstrom, Laleh G.

AU - Warner, Susanne G.

N1 - 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.

PY - 2020/7

Y1 - 2020/7

N2 - 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.

AB - 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.

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KW - Female

KW - Gastrointestinal Neoplasms/economics

KW - Humans

KW - Income

KW - Male

KW - Middle Aged

KW - Poverty/psychology

KW - Stress, Psychological/economics

KW - Surveys and Questionnaires

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The impact of financial toxicity in gastrointestinal cancer patients

Abstract

Bibliographical note

Keywords

PubMed: MeSH publication types

UN SDGs

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