Financial toxicity associated with poorer quality of life, survival outcomes

COPENHAGEN, Denmark — Patients who experienced worsening financial burden after cancer diagnosis experienced poorer quality of life and an increased risk for mortality, according to a pooled analysis of 16 trials presented at the European Society for Medical Oncology Congress.

“Financial difficulties may impact the outcome of cancer patients even in countries where the national public health system covers most of the expenses and, therefore, it is our mission to understand what are the detriments of such difficulties and whether some of them may be actionable,” Francesco Perrone, MD, PhD, director of the clinical trials unit at National Cancer Institute of Naples, Italy, said in a press release.

Perrone and colleagues pooled data from 16 prospective multicenter trials in lung, breast and ovarian cancers that comprised 3,760 patients. All patients completed the EORTC quality-of-life C30 questionnaire, which in one question asks patients to rank their financial difficulties related to their disease or treatment as “not at all” to “very much.”

Researchers defined financial burden as any financial difficulty reported at baseline. Worsening in financial difficulty from baseline to a subsequent assessment was considered to be financial toxicity.

Twenty-six percent of patients reported a baseline financial difficulty. These patients appeared to be more likely to experience poorer global quality of life (OR = 1.35; 95% CI, 1.08-1.7). However, baseline financial difficulties did not increase risk for death (HR = 0.94; 95% CI, 0.85-1.04) or severe toxicity (OR = 0.9; 95% CI, 0.76-1.06).

During treatment, 2,735 patients completed subsequent questionnaires. Results showed that 616 patients (22.5%) developed a financial toxicity since baseline.

Financial toxicities were associated with an increased risk for death (HR = 1.2; 95% CI, 1.05-1.37).

“The size of this impact is moderate but not negligible; it is similar in size to the effect that pushed some new drugs into the market over the last 20 years,” Perrone said.

“Based on common sense, we oncologists should pay attention to the social status and economic possibilities of our patients and try to advise them regarding their rights in terms of public support and respect due to their condition,” he added.

Results from this study show that even patients who do not have to pay for treatment because they are participating in a clinical trial may enter the trial already experiencing financial difficulties, Nathan I. Cherny, MD, director of the cancer pain and palliative care service in the oncology department at Shaare Zedek Medical Center in Jerusalem, said in the release.

“These findings underscore that even in the absence of payment or copayment of medications, being ill with cancer often has severe and progressive financial impact on patients and their families,” Cherny said. “In the absence of substantial supports and benefits, this may not only compromise quality of life, but also patient outcomes.” – by Alexandra Todak

Reference:

Perrone F, et al. Abstract LBA1020O_PR. Presented at: European Society for Medical Oncology Congress; Oct. 7-11, 2016; Copenhagen, Denmark.

Disclosure: The researchers report no relevant financial disclosures.