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S1417CD: A Prospective Multicenter Cooperative Group-Led Study of Financial Hardship in Metastatic Colorectal Cancer
Veena Shankaran1,2, Joseph M Unger3, Amy K Darke3
1Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
Background:
Financial toxicity is a growing problem in oncology, but no prior studies have prospectively measured the financial impact of cancer treatment in a diverse national cohort of newly diagnosed cancer patients. S1417CD was the first cooperative group-led multicenter prospective cohort study to evaluate financial hardship in metastatic colorectal cancer (mCRC) patients.
Methods:
Patients aged 18 years or older within 120 days of mCRC diagnosis completed quarterly questionnaires for 12 months. We estimated the cumulative incidence of major financial hardship (MFH), defined as 1 or more of increased debt, new loans from family and/or friends, selling or refinancing home, or 20% or more income decline. We evaluated the association between patient characteristics and MFH using multivariate cox regression and the association between MFH and quality of life using linear regression.
Results:
A total of 380 patients (median age = 59.9 years) were enrolled; 77.7% were White, 98.0% insured, and 56.5% had annual income of $50 000 or less. Cumulative incidence of MFH at 12 months was 71.3% (95% confidence interval = 65.7% to 76.1%). Age, race, marital status, and income (split at $50 000 per year) were not statistically significantly associated with MFH. However, income less than $100 000 and total assets less than $100 000 were both associated with greater MFH. MFH at 3 months was associated with decreased social functioning and quality of life at 6 months.
Conclusions:
Nearly 3 out of 4 mCRC patients experienced MFH despite access to health insurance. These findings underscore the need for clinic and policy solutions that protect cancer patients from financial harm.
Insights
Over 70% of metastatic colorectal cancer patients faced major financial hardship within a year of diagnosis. This financial toxicity significantly impacted their quality of life, highlighting an urgent need for supportive interventions.
Area of Science:
- Oncology
- Health Economics
- Patient Advocacy
Background:
- Financial toxicity is an escalating concern in cancer care.
- Previous research lacked prospective data on the financial burden in a diverse patient population.
- The S1417CD study was the first cooperative group-led, multicenter, prospective cohort study to assess financial hardship in metastatic colorectal cancer (mCRC).
Purpose of the Study:
- To prospectively evaluate the incidence and predictors of major financial hardship (MFH) in patients with newly diagnosed mCRC.
- To examine the association between MFH and patient characteristics.
- To determine the impact of MFH on patients' quality of life.
Main Methods:
- Enrolled 380 patients aged 18+ within 120 days of mCRC diagnosis.
- Collected quarterly questionnaires for 12 months.
- Defined and estimated cumulative incidence of MFH (increased debt, new loans, home equity changes, or income decline >20%).
- Utilized Cox regression for patient characteristics and MFH, and linear regression for MFH and quality of life.
Main Results:
- The cumulative incidence of MFH at 12 months was 71.3%.
- Lower income (<$100,000) and lower total assets (<$100,000) were associated with greater MFH.
- MFH at 3 months correlated with reduced social functioning and quality of life at 6 months.
Conclusions:
- A significant majority of mCRC patients experience major financial hardship, even with health insurance.
- These findings emphasize the critical need for systemic solutions at clinical and policy levels to mitigate financial harm for cancer patients.
- Addressing financial toxicity is crucial for improving patient outcomes and well-being in oncology.
