Financial Toxicity Is Common Among and Harmful to Older Patients with Cancer

Patients aged 70 years or older with cancer may be susceptible to financial toxicity, which is correlated with poorer health-related quality of life (HRQoL), according to a study.

“Almost half of conversations among patients reporting [financial toxicity] demonstrated costs are being actively discussed. Resources and interventions are needed to manage [financial toxicity],” the researchers stated.

They used baseline data from the Improving Communication in Older Cancer Patients and Their Caregivers study to conduct a cross-sectional secondary analysis. In the present study, patients aged 70 years or older with advanced cancer answered three questions pertaining to financial toxicity:

  • “At any time in the past 3 months have you taken less medication than was prescribed for you because of the cost?”
  • “When you think about the amount of income that you have available in a typical month, is there enough for your food and housing costs?”
  • “When you think about the amount of income that you have available in a typical month, is it enough for things you really need like clothing, medicine, repairs to the home or transportation?”

Financial toxicity was defined as answering “yes” to the first question, or “no” to either the second or third question.

This analysis consisted of 536 patients with a mean age of 76.6 years (range, 70-96 years); 262 patients were female, 39 were Black/African American, and 101 had Medicare insurance alone. Most patients were unemployed or retired (n=499).

Overall, 98 patients reported financial toxicity (18.3%). Among these patients, the mean (standard deviation) age was 76.4 (5.4) years, 59 were female, 14 were Black/African American, and 29 had Medicare insurance alone. As in the overall cohort, most of these patients were not employed (n=91).

Patients with financial toxicity were more likely to have depression (β = 0.81; 95% confidence interval [CI], 0.15-1.48), anxiety (β = 1.67; 95% CI, 0.74-2.61), and distress (β = 0.73; 95% CI, 0.08-1.39), and they had lower HRQoL (β = –5.30; 95% CI, –8.92 to –1.69).

Just about half of patients with financial toxicity discussed costs with their health care provider (49%); 79% of conversations were initiated by oncologists or patients. The discussions yielded four themes, identified by the study authors:

  • statements regarding cost of care
  • ability to afford medical prescriptions
  • indirect consequences associated with inability to work and provide for family
  • cost burden in nontreatment domains

The study was published in JAMA Network Open.