Longitudinal Associations Between Financial Toxicity and Health-Related Quality of Life for Patients With Cancer

Evaluate the longitudinal relationship between financial toxicity (FT), health-related quality of life (HR-QOL), and psychological distress for patients with cancer.

Adults with cancer applying for foundation financial assistance or receiving treatment participated in a longitudinal survey study at any point in their cancer journey and 1, 3, and 6 months later. Validated surveys measured FT (Comprehensive Score for FT [COST]), HR-QOL (Functional Assessment of Cancer Therapy-General [FACT-G]), and psychological distress (Brief-Profile of Mood States [Brief-POMS]). Multilevel ordinal logistic and linear regression models assessed longitudinal relationships.

Out of 1,112 approached, 732 (66%) completed the enrollment survey with subsequent response rates of 66%, 58%, and 52% at 1, 3, and 6 months, respectively. Participants had a mean age of 68 years. Most were non-Hispanic White (86%), male (57%), Medicare beneficiaries (82%), and had hematologic malignancies (53%). Most common cancer types were multiple myeloma and prostate cancer. Most (80%) had FT at enrollment (grade 1+ or COST <26), and FT was higher in earlier calendar months. Access to a financial counselor was associated with lower FT for those who desired a referral (adjusted odds ratio [aOR], 0.18). Previous (OR, 1.58) and current (OR, 1.73) intravenous chemotherapy were associated with higher FT. In multivariable multilevel models clustered by participants, higher FT was significantly associated with lower HR-QOL and greater psychological distress. The probability of any FT decreased from 79% at enrollment to 72% at 1 month and 68% at 3 and 6 months.

Patients with various cancer types had associations between higher FT, lower HR-QOL, and more psychological distress across repeated measures over 6-month intervals. FT screening should be repeated across the cancer care continuum, especially early in the calendar year. This will allow interventions to improve patients' emotional and physical well-being.