Frequency and Correlates of Financial Distress in Patients with Advanced Cancer

Financial distress, a term used to encompass the negative consequences of the cost of medical treatment, can lead to delay of care, psychological distress, or even bankruptcy for patients and/or their families. Cancer is an expensive medical condition, and this distress is not routinely assessed.

The primary objective of this study was to determine the frequency of high financial distress in patients with advanced cancer. Secondary objectives include determining the association between high financial distress with clinical and demographic characteristics. Primary outcome was based on the result of the InCharge Financial Distress/Financial Well-Being Scale (IFDFW), an eight-question survey with each question rated from 1 (overwhelming stress) to 10 (no stress at all). High financial distress was defined as a mean score of ≤4.0. Quality of life was assessed with Edmonton Symptom Assessment Scale-Financial and Spiritual Distress (ESAS-FS), Comprehensive Score for Financial Toxicity-Functional Assessment of Chronic Illness Therapy, and FACT-G surveys. Demographic data was collected from questionnaire and chart review.

One hundred and forty adult patients with advanced cancer were enrolled. The average patient age was in 50s, 67% were White, 12% Hispanic, 14% African American, and 4% Asian. Of the participants, 35/140 patients (25%) reported high financial distress. Patients with high financial distress were younger (55.1 vs. 59.3 years old, p = 0.04), less likely to be married (51.4% vs. 82.9%, p = 0.002), less likely to be working full time (23% vs. 31%, p = 0.001), and had lower annual household income (49% making less than $40,000 a year vs. 13%, p <0.001). There was a significant association between financial distress, symptom burden, and decreased quality of life. There was a strong correlation between the IFDFW score and single item 0-10 financial distress ESAS (0.6, p <0.001).

High financial distress is frequent among patients with advanced cancer. It was associated with younger age, nonmarried status, symptom severity, and decreased quality of life. Our findings suggest that financial distress should be monitored in supportive cancer care.