Patients with metastatic colorectal cancer who were below a certain income level appeared to be more susceptible to severe financial hardship.
Major financial hardship occurred in 3 of 4 patients with metastatic colorectal cancer, regardless of health insurance status, according to results of a multicenter cooperative group study published in Journal of the National Cancer Institute.
After 12 months, the cumulative incidence of major financial difficulties was 71.3% (95% CI, 65.7%-76.1%). Patient characteristics such as age, race, marital status, and income distribution of $50,000 per year were not significantly associated with major financial hardship. However, those who had income and/or total assets below $100,000 were associated with greater financial distress.
A total of 368 patients were eligible, 73% of whom were alive after 1 year of follow-up. Overall, 82.1% of patients met the primary endpoint or had a 12-month assessment available. The mean age was 60.2 years, and 62.8% of patients were under 65 years of age. Additionally, 61.9% of patients were male and 13.0% were black. A total of 30.9% of patients had a total household income of $0 to $25,000, 25.5% earned $25,001 to $50,000, 14.7% earned $50,001 to $75,000, 8.4% earned $75 001 to $100,000 and 17.7% earned over $100,000. Most patients had private insurance (46.5%), while others had Medicare (38.9%), Medicaid (11.9%), other (0.82%) or were uninsured (1.9%). Patients were geographically distributed in the Midwest (47.3%), the South (23.1%), the West (20.4%), and the Northeast (9.2%). In the study, 19.8% of patients were from rural areas.
The cumulative incidence of new debt at 12 months was 57.6% (95% CI, 51.7%-63.0%), 26.6% (95% CI, 21.3%-32.0%) at 20 % or more decline in income, 26.0% (95% CI, 21.5%-30.7%) for new loans from family and/or friends, 3.4% (95% CI, 1.7%- 5.9%) for home refinancing and 2.6% (95% CI, 1.3%-4.7%) for selling a home. Major financial difficulties were commonly reported at baseline, with 24.9% (95% CI, 20.9%-29.5%) experiencing difficulties at 3 months, 53.8% (95% CI, 48.5%-58 .8%) at 6 months and 63.0% (95% CI, 57.8%-67.8%) at 9 months.
Patients who were unemployed were statistically significantly less likely to have major financial difficulties, but this was thought to be confounded by age, with older patients more likely to have greater assets and savings. Age under 65 years was associated with a statistically significant increased risk of major financial hardship (HR, 1.71; 95% CI, 1.06-2.75). Lower total assets were also specifically associated with a greater likelihood of major financial distress at all points of decline in total assets.
At 3 months, patients with severe financial difficulties were more likely to have lower European Organization for Research and Treatment of Cancer (EORTC) scores at 6 months. The analysis was adjusted for quality of life at 3 months, although only the social functioning score and the global health status score were statistically significant.
Sensitivity analysis showed that the 1-year cumulative incidence of major financial distress was 43.0% (95% CI, 37.3%-48.6%) after omitting the measure of new debt. A total of 32.7% (95% CI, 27.8%-37.7%) of patients had accumulated new debt by 1 year, and the overall estimate of major financial difficulties at 1 year was 58.2% (95% CI, 52.5%-63.6%) ).
Post hoc analysis showed that for each increase, risk factors such as income below 100,000 that increased from 0 to 1 and 1 to 2 had a 49% increase in the risk of major financial hardship (HR, 1.49; 95% CI, 1.21-1.85; P <.001). At 12 months, the cumulative incidence of major financial hardship was similar between homeowners at 69.9% (95% CI, 62.8%-76.0%) and nonhomeowners at 71.8% (95% CI, 62.3 %-79.2%).
Shankaran V, Unger JM, Darke AK, et al. S1417CD: a prospective multicenter cooperative cohort study of financial hardship in patients with metastatic colorectal cancer. J Natl Cancer Inst. 2022; 114 (3): 372-380. doi:10.1093/jnci/djab210