Financial toxicity worsens quality of life for partners of colorectal cancer survivors
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Key takeaways:
- Thirty-nine percent of partners missed 1 week to 1 month of work and 38% lost income due to the patient’s cancer.
- Nearly two-thirds of partners reported financial burden.
Partners of colorectal cancer survivors experienced long-term financial toxicity associated with worse health-related quality of life, according to results of a survey study published in JAMA Network Open.
Researchers recommended multilevel interventions for both patients and partners to address individual- and systemic-level factors associated with financial toxicity and its impact on health-related quality of life.
Rationale and methodology
“Financial toxicity or hardship is a significant effect of cancer and its treatment and is associated with poor health outcomes for patients and survivors,” Christine M. Veenstra, MD, MSHP, associate professor in the division of hematology/oncology and the department of internal medicine at University of Michigan, told Healio. “Financial toxicity extends to caregivers and partners, too. We wanted to understand how financial toxicity affects caregivers’ health outcomes, such as anxiety and depressive symptoms, fatigue, overall quality of life or well-being.”
Researchers recruited 501 survivors of stage III colorectal cancer from a rural community oncology practice in Montana, an academic center in Michigan and the Georgia Cancer Registry. They used a mixed-method study design and gathered data through a mailed dyadic survey for survivors with a separate survey for their partners.
The investigators assessed financial burden with the Personal Financial Burden scale, and debt and financial worry with a single survey item. They used the PROMIS-29+2 Profile, version 2.1, to measure health-related quality of life, multivariable regression analysis to assess associations of financial toxicity with individual domains of health-related quality of life, and thematic analysis to explore partner perspectives on financial toxicity.
They merged quantitative and qualitative findings to explain the connection between financial toxicity and health-related quality of life.
Findings
Overall, 428 patients reported having a partner and 311 partners (72.6%) returned surveys. The final analysis included 307 patient-partner dyads with completed surveys. Partners had a mean age of 63.7 years; most were aged younger than 65 years (56.1%), women (62.6%) and white (85.7%).
“Of partners who worked full- or part-time when the patient was diagnosed, 39% missed between 1 week and 1 month of work and 38% said they lost income due to the patient’s cancer,” Veenstra said. “Moreover, nearly two-thirds of partners reported financial burden — including cutting down on expenses, activities, food or clothes, or using savings — and approximately one-third of partners experienced high financial worry, which increased the more they lost income or missed work. [In addition,] 29% of partners reported debt related to the cancer diagnosis and treatment.”
High financial burden appeared associated with worse health-related quality of life in the pain interference domain among partners (mean score, 0.08; P = .03). Debt appeared associated with worse health-related quality of life in the sleep disturbance domain (mean score, 0.32; P = .03), and high financial worry appeared associated with worse health-related quality of life in the social functioning (mean score, 0.37; P = .005), fatigue (mean score, 0.33; P = .03) and pain interference (mean score, 0.33; P = .02) domains.
“Across the seven health-related quality of life domains, financial toxicity appeared consistently associated with worse quality of life,” Veenstra said. “Partners described financial toxicity as primarily related to health insurance and employment status. But they also reported extra emotional spending, disrupted social lives, having to ask family and friends for help with medical expenses, and worry over what could have happened if they hadn’t had insurance. In addition, younger partners were significantly more likely to report financial burden and debt, which is striking as the prevalence of colorectal cancer among younger adults has increased in recent years.”
Implications
The findings are a unique contribution to the financial toxicity literature and will help to better tailor interventions to mitigate financial toxicity and improve health-related quality of life for both patients and partners, Veenstra told Healio.
“Future research will analyze the impact of financial toxicity on patients and partners together,” she said. “We hope to identify employer-level considerations or other interventions that could help mitigate financial toxicity among patients and their partners.”
Such interventions could include an expansion of those currently provided to patients, Ayush Peddireddi, BA, BS, of The Ohio State University College of Medicine, and Emeline M. Aviki, MD, MBA, of the gynecology service in the department of surgery at Memorial Sloan Kettering Cancer Center, wrote in an editorial that accompanied the study.
“One approach could be to expand education to partners to help them understand not only the financial costs of care, which may include indirect costs such as transportation expenses, but also the time burden associated with long-term care support, which may include time off from work,” they wrote. “Another strategy could be to institute a partner-centered financial navigation program to help patient supporters plan, budget and optimally use family leave offered by their employers.”
References:
- Ghazal LV, et al. JAMA Netw Open. 2023;doi:10.1001/jamanetworkopen.2023.5897.
- Peddireddi A, et al. JAMA Netw Open. 2023;doi:10.1001/jamanetworkopen.2023.5785.
For more information:
Christine M. Veenstra, MD, MSHP, can be reached at cveenstr@med.umich.edu.
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