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Patients with head and neck cancer often resort to cost-coping strategies
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Most patients with locally advanced head and neck cancers rely on cost-coping strategies that alter their lifestyle to manage the financial burden of their care, according to results of a prospective longitudinal study presented at the Multidisciplinary Head and Neck Cancer Symposium.
Further, a patient’s perceived social isolation appeared to increase the risk for suboptimal adherence to medication and use of health care during treatment.
Sunny Kung
“Although there is a high cure rate, there is also high morbidity because head and neck cancer require multiple modalities such as chemotherapy, radiotherapy and surgery,” Sunny Kung, a second-year medical student at University of Chicago Pritzker School of Medicine, said during a press briefing. “Treatment is quite expensive, so patients may feel intense financial side effects in addition to the physical side effects.”
Kung and colleagues conducted this study by identifying 73 patients (male, 78%; non-Hispanic white, 74%) with locally advanced head and neck cancer treated at University of Chicago between May 2013 and November 2014. Most patients (54.8%) had private health insurance.
Patients participated in monthly surveys over 6 months that assessed life-altering cost-coping strategies, out-of-pocket costs, loss of productivity, medication compliance and baseline perceived social isolation.
Average medical costs, including direct medical costs and insurance premiums on average, were $1,589 per month for each patient.
Overall, 69% of the patients used at least one lifestyle-altering coping strategy. These included using all or a portion of their savings (62%), borrowing money or using credit (42%), selling possessions or property (25%) or having family members take on additional hours of work to defray medical costs (23%).
In a multivariate analysis, the researchers found that Medicaid patients were more likely to use these coping strategies than insured patients (OR = 42.3; 95% CI, 4.19-428).
Additionally, patients with higher out of pocket costs (P = .004) and decreased wealth (P = .002) appeared more likely to use cost-coping strategies.
Perceived social isolation occurred in 9.5% of the patients prior to the start of treatment. These patients were more likely to rely on these coping strategies than the rest of the cohort (OR = 11.5; 95% CI, 1.8-73.8).
Patients with perceived social isolation also took less prescribed medication than the rest of the cohort (mean days missing medication, 21.4 vs. 5.45; P = .02) and missed more medical appointments than the remainder of the cohort (mean, 7 vs. 3; P = .007).
A trend also existed in which patients who were socially isolated experienced a longer length of stay in hospitals over a 6-month period than the remainder of the cohort (mean, 32.7 vs. 27.6 days).
“In this environment where the cost of medical care is increasing, it is important for physicians and patients to understand the financial side effects of their cancer care,” Kung said. “[We need] to find patient-specific interventions in order to help these patients optimize their care.” – by Anthony SanFilippo
Reference:
Kung S, et al. Abstract 323. Presented at: Multidisciplinary Head and Neck Cancer Symposium; Feb. 18-19, 2016; Scottsdale, Ariz.
Disclosures: Kung reports no relevant financial disclosures. One researcher reports a speakers bureau role with AstraZeneca.