Patient-reported financial toxicity and adverse medical consequences in head and neck cancer.

Beeler WH, Bellile EL, Casper KA, Jaworski E, Burger NJ, Malloy KM, Spector ME, Shuman AG, Rosko A, Stucken CL, Chinn SB, Dragovic AF, Chapman CH, Owen D, Jolly S, Bradford CR, Prince MEP, Worden FP, Jagsi R, Mierzwa ML, Swiecicki PL. Patient-reported financial toxicity and adverse medical consequences in head and neck cancer. Oral Oncology. 2020 Feb 1; 101:104521.

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Abstract:

OBJECTIVES: Financial toxicity (FT) is a significant barrier to high-quality cancer care, and patients with head and neck cancer (HNCA) are particularly vulnerable given their need for intensive support, daily radiotherapy (RT), and management of long-term physical, functional, and psychosocial morbidities following treatment. We aim to identify predictors of FT and adverse consequences in HNCA following RT. MATERIALS AND METHODS: We performed a prospective survey study of patients with HNCA seen in follow-up at an academic comprehensive cancer center (CCC) or Veterans Affairs hospital between 05/2016 and 06/2018. Surveys included validated patient-reported functional outcomes and the COST measure, a validated instrument for measuring FT. RESULTS: The response rate was 86% (n  =  63). Younger age and lower median household income by county were associated with lower COST scores (i.e., worse FT) on multivariable analysis (p  =  .045 and p  =  .016, respectively). Patients with worse FT were more likely to skip clinic visits (RR (95% CI) 2.13 (1.23-3.67), p  =  .007), be noncompliant with recommended supplements or medications (1.24 (1.03-1.48), p  =  .02), and require supportive infusions (1.10 (1.02-1.20), p  =  .02). At the CCC, patients with worse FT were more likely to require feeding tubes (1.62 (1.14-2.31), p  =  .007). Overall, 36% reported that costs were higher than expected, 48% were worried about paying for treatment, and 33% reported at least a moderate financial burden from treatment. CONCLUSION: HNCA patients experience substantial FT from their diagnosis and/or therapy, with potential implications for medical compliance, QOL, and survivorship care.