Cancer patients with limited finances more likely to have increased symptoms and poorer quality of life

If you’re a lung or colorectal cancer patient, what’s in your wallet could determine your level of suffering and quality of life during treatment, according to a new study by Dana-Farber Cancer Institute researchers. The findings appear today in the Journal of Clinical Oncology.

“Most of the studies looking at financial stress look at what cancer does to your finances after diagnosis,” said Christopher Lathan, MD, MS, MPH, lead author of the study and a thoracic oncologist at Dana-Farber. “We were interested in looking at what happens when you have financial distress, defined in our study as little or no savings at the time of your diagnosis, and how that factor can impact quality of life.”

In the study, researchers looked to measure the association between patient financial strain and symptom burden and quality of life (QOL) for patients with new diagnoses of lung or colorectal cancer.

Patients participating in the Cancer Care Outcomes Research and Surveillance study were interviewed about their financial reserves, QOL, and symptom burden at 4 months of diagnosis and, for survivors, at 12 months of diagnosis. Researchers assessed the association of patient-reported financial reserves with patient-reported outcomes, including the Brief Pain Inventory, symptom burden on the basis of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C30, and QOL on the basis of the EuroQoL-5 Dimension scale.

Among patients with lung and colorectal cancer, 40 percent and 33 percent, respectively, reported limited financial reserves. Relative to patients with more than 12 months of financial reserves, those with limited financial reserves reported significantly increased pain for lung and colorectal symptoms, greater symptom burden, and poorer QOL. With decreasing financial reserves, a clear dose-response relationship was present across all measures of well-being. These associations were also manifest for survivors reporting outcomes again at 1 year and persisted after adjustment for stage, co-morbidity, insurance, and other clinical attributes.

“We found that patients who had financial distress at the time of diagnosis were more likely to have poorer outcomes in physical and mental quality of life measures, pain, and symptom burden,” noted Lathan. “This effect persisted after adjusting for stage of disease, co-morbidity, income, age, and insurance.”

Researchers say the findings highlight the need to evaluate patients for potential financial distress at the time of diagnosis and to allow for clinicians to target appropriate resources and treatments for those patients who were already struggling before their cancer diagnosis.

Deborah Schrag, MD, MPH, of Dana-Farber is senior author on the paper.

The study is supported by grants from the National Cancer Institute (1P50CA148596 and K01 CA124581). The Cancer Care Outcomes Research and Surveillance Consortium was supported by grants from the National Cancer Institute to the Statistical Coordinating Center (U01 CA093344) and the National Cancer Institute–supported Primary Data Collection and Research Centers: Dana-Farber Cancer Institute/Cancer Research Network (U01 CA093332), Harvard Medical School/Northern California Cancer Center (U01 CA093324), RAND/UCLA (U01 CA093348), University of Alabama at Birmingham (U01 CA093329), University of Iowa (U01 CA093339), University of North Carolina (U01 CA093326) and by a Department of Veterans Affairs grant to the Durham VA Medical Center (CRS 02-164).