Cancer patients who have financial difficulties have significantly worse quality of life during treatment and may be at higher risk of death, according to the results of a pooled analysis presented at the European Society for Medical Oncology (ESMO) 2016 Congress, held Oct. 7-11, in Copenhagen, Denmark.
”Financial difficulties may impact the outcome for cancer patients even in countries where the national public health system covers most of the expenses, and therefore, it is our mission to understand what are the determinants of such difficulties and whether some of them may be actionable,” principal investigator Francesco Perrone, MD, director of the Unità Sperimentazioni Cliniche at the National Cancer Institute of Naples, Italy, said in a press release.
Researchers examined data from 3,670 patients with either lung, breast or ovarian cancer in 16 prospective multi-center trials in Italy. Patients in these cohorts were asked to fill the European Organisation for Research and Treatment of Cancer (EORTC) quality-of-life C30 questionnaire, which included one entry where patients had to rate the financial difficulties related to their disease or treatment.
Results revealed that those who showed any financial difficulty at baseline (26% of patients) had a 35% greater risk of exhibiting a worse quality of life.
Patients also were asked to complete a subsequent questionnaire, which allowed researchers to assess if changes in patients’ financial burdens during the period of treatment had any impact on their outcomes. Among the 2,735 who filled the second questionnaire, 22.5% had a worsening in their financial score, which the researchers termed “financial toxicity.” In these patients, financial toxicity was associated with a 20% higher risk of death.
The researchers were expecting that financial burden could influence patients’ quality of life, but they were surprised to find that the risk of death also was associated with financial problems.
“The size of this impact is moderate, but not negligible; it is similar in size to the effect that pushed some new drugs into the market over the last twenty years,” Perrone said. “Based on common sense, we oncologists should pay attention to the social status and economic possibilities of our patients and try to advise them regarding their rights in terms of public support and respect due to their condition,” she said.
Nathan Cherny, MD, from the Shaare Zedek Medical Center in Jerusalem, commented on the study, stating that the results are indicative that even patients who do not have to pay for their treatments (those included in clinical trials, for example), enter the studies with some degree of financial burden.
“These findings underscore that even in the absence of payment or co-payment of medications, being ill with cancer often has severe and progressive financial impact on patients and their families,” Cherny said. “In the absence of substantial supports and benefits, this may not only compromise quality of life, but also patient outcomes.”