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Published on: March 6, 2018
Financial Toxicity Following Locally Advanced Rectal Cancer Treatment
Dillon C Cheung1,2, Chi Zhang1,2, David Etzioni1
1Department of Surgery, Mayo Clinic Arizona, Phoenix, Arizona.
Background:
Patients with locally advanced rectal cancer face substantial costs related to multimodal therapy. However, the extent of this burden is poorly characterized.
Objective:
To characterize the prevalence and predictors of patient-reported financial toxicity after treatment for locally advanced rectal cancer.
Design:
Multicenter retrospective cohort study with a cross-sectional survey administered to assess patients' financial concerns as well as clinicodemographic data.
Setting:
Three high-volume tertiary academic centers.
Patients:
Patients who completed treatment for pathological stage II to III rectal adenocarcinoma between 2000 and 2019 and were alive.
Main Outcome Measures:
Patient-reported financial toxicity and risk factors associated with financial toxicity.
Results:
A total of 523 patients were identified, 190 (36.3%) responded to the survey, and 2 were excluded for incomplete surveys. Of the responders, 163 (86.7%) were identified as having financial toxicity related to their cancer diagnosis, and most (96.8%) had insurance. Patients with financial toxicity were less likely to have fully paid medical leave (39.8% vs 75%; p = 0.03) compared to patients without financial toxicity. They also reported increased difficulty paying bills ( p < 0.001) and decreased monthly household income ( p < 0.001) due to their diagnosis. Furthermore, these patients reported increased difficulty paying for transportation to medical appointments ( p = 0.002) and were less likely to be completely satisfied with their insurance coverage ( p = 0.003). Feeling well informed regarding treatment-related costs was associated with decreased odds of financial toxicity (OR 0.14; 95% CI, 0.02-0.78; p = 0.02), whereas taking unpaid leave for treatment was associated with increased odds of financial toxicity (OR 4.71; 95% CI, 1.36-16.34; p = 0.01).
Limitations:
Cross-sectional design and moderate response rate may introduce selection and recall bias.
Conclusions:
Patients undergoing treatment for locally advanced rectal cancer, including those insured, are at risk for financial toxicity due to direct and indirect costs. Effective communication between these patients and physicians regarding the economic implications of treatment is essential to reducing financial toxicity. See Video Abstract .
Toxicidad Financiera Tras El Tratamiento Del Cncer Rectal Localmente Avanzado:
ANTECEDENTES:Los pacientes con cáncer de recto localmente avanzado enfrentan costos sustanciales relacionados con la terapia multimodal. Sin embargo, la magnitud de esta carga está poco caracterizada.OBJETIVO:Caracterizar la prevalencia y los predictores de la toxicidad financiera reportada por los pacientes después del tratamiento para el cáncer de recto localmente avanzado.DISEÑO:Estudio de cohorte retrospectivo multicéntrico con una encuesta transversal para evaluar las preocupaciones financieras de los pacientes, así como datos clínico-demográficos.ESCENARIO:Tres centros académicos terciarios de alto volumen.PACIENTES:Pacientes que completaron el tratamiento para el adenocarcinoma de recto en estadio patológico II-III entre 2000 y 2019 y estaban vivos.PRINCIPALES MEDIDAS DE RESULTADOS:Toxicidad financiera reportada por los pacientes y factores de riesgo asociados con la toxicidad financiera.RESULTADOS:Se identificó a un total de 523 pacientes, 190 (36,3%) respondieron a la encuesta y 2 fueron excluidos por encuestas incompletas. De los encuestados, 163 (86,7 %) presentaron toxicidad financiera relacionada con su diagnóstico de cáncer, y la mayoría (96,8 %) contaba con seguro médico. Los pacientes con toxicidad financiera tuvieron menos probabilidades de tener licencia médica con goce de sueldo completo (39,8 % frente a 75 %; p = 0,03) en comparación con los pacientes sin toxicidad financiera. También informaron mayor dificultad para pagar facturas ( p < 0,001) y una disminución de los ingresos familiares mensuales ( p < 0,001) debido a su diagnóstico. Además, estos pacientes informaron mayor dificultad para pagar el transporte a las citas médicas ( p = 0,002) y menor probabilidad de estar completamente satisfechos con su cobertura médica ( p = 0,003). Sentirse bien informado sobre los costos relacionados con el tratamiento se asoció con una menor probabilidad de toxicidad financiera (OR: 0,14; IC del 95 %: 0,02-0,78; p = 0,02), mientras que tomar una licencia sin sueldo para el tratamiento se asoció con una mayor probabilidad de toxicidad financiera (OR: 4,71; IC del 95 %: 1,36-16,34; p = 0,01).LIMITACIONES:El diseño transversal y la tasa de respuesta moderada pueden introducir sesgos de selección y de recuerdo.CONCLUSIONES:Los pacientes en tratamiento para el cáncer de recto localmente avanzado, incluidos los asegurados, corren el riesgo de sufrir toxicidad financiera debido a los costos directos e indirectos. Una comunicación eficaz entre estos pacientes y los médicos sobre las implicaciones económicas del tratamiento es esencial para reducir la toxicidad financiera. ( AI-generated translation ).
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