Financial Burden of Cancer Treatment Weighs Heavily on Patients

Nearly two-thirds of patients diagnosed with colorectal cancer report experiencing financial burden during their treatment, according to a study from the University of Michigan. In particular, younger patients who worked in lower-paying jobs and those who were treated with chemotherapy report having concerns about finances during the course of their treatment. Results are published in Medical Care.

“Community oncologists should recognize when patients are experiencing financial burden,” said Christine M. Veenstra, MD, MSPH, lead author and a clinical lecturer in the Division of Hematology/Oncology at the University of Michigan, School of Medicine. “Asking a general question like, ‘Are you worried about your finances?’ could be enough to start the dialogue,” she said. “That 1 question asked during any point of the visit, lets the patient know that the oncologist is keyed in,” she said.

Patients may not bring up the issue of financial difficulty because they might not think it’s the appropriate time or they might think it’s the clinician’s job to focus on the cancer, not the financial burden that accompanies it. “But the oncology community has recognized that these are important issues to discuss with patients. It should be discussed in parallel with treatment recommendations because financial burden can have an effect on the care the patient receives,” Veenstra said.

The researchers hope their findings inform policy, also. “Policies should support patients while they undergo cancer treatment,” said Veenstra, “We wanted to draw attention to employers or insurance providers that these patients might need additional support measures to help them get the life-saving treatments they need,” she said. Job support measures might be helpful, including paid sick leave or disability benefits, said Veenstra.

Other studies have shown that patients who are experiencing financial burden may not adhere to all the recommended treatments. For example, patients may skip chemotherapy or doses of other supportive medications like anti-nausea agents because of the financial burden, said Veenstra.

The study involved 956 patients identified through the Surveillance, Epidemiology, and End Results cancer database who had been treated with stage 3 colorectal cancer and were located in the Metro Detroit area and the state of Georgia. The researchers developed a 7-question tool that included questions about the use of savings, borrowing money or taking out a loan, cutting down on spending for food/clothes, and cutting down on recreational activities.

The researchers found that 38% of patients did not indicate financial burden based on the 7 questions. Of the remaining 62%, 29% indicated 1-2 areas of burden, 23% identified 3-4 areas of burden, and 9% indicated 5 or more burdens. Nearly half of patients noted that they cut down on expenses in general because of their cancer treatment.

When compared with patients who did not use adjuvant chemotherapy, patients who used chemotherapy were more likely to use savings (36% vs 21%; P <.001), borrow money or take out a loan (14% vs 5%; P =.002), miss credit card payments (14% vs 5%; P <.001), cut down on spending for food/clothes (33% vs 15%; P <.001), cut down on recreational activities (39% vs 16%; P <.001) or reduce general expenses (57 vs 26%; P <.001).

“We want patients, clinicians, employers, and insurers to recognize that this burden does exist and the financial issues can be difficult to cope with,” said Veenstra. In addition, through policy changes “we can help patients get the care that they need.”

Reference:

Veenstra CM, Regenbogen SE, Hawley ST, Griggs JJ, Banerjee M, Kato I, et al. A composite measure of personal financial burden among patients with stage III colorectal cancer. Med Car.2014;52:957-962.