ASPO Abstracts
A New Survivorship and Disparity Concern in Patients with Metastatic Lung Cancer: Financial Hardship in the Setting of Immunotherapy
Category: Cancer Health Disparities
Conference Year: 2019
Abstract Body:
Purpose: Financial hardship is related to poor quality of life and mortality and may increase with the advent of costly therapies like immunotherapy. The purpose of this study was to describe financial hardship and identify risk factors in patients undergoing immunotherapy for metastatic non-small cell lung cancer. Methods: From October 2017 to July 2018, we surveyed patients undergoing immunotherapy with or without chemotherapy for metastatic lung cancer at an academic medical center. We used a multidimensional framework to describe financial hardship in terms of material costs, coping with costs, and affective impact. Independent samples t-tests and contingency tables tested the association between hardship (AHRQ Medical Expenditure Panel Survey; FACIT-COST [lower scores indicate higher financial distress]) and sociodemographic and clinical factors. Results: The sample included 60 patients (Mean age = 62.5 yrs; 40% male; 75% Caucasian) who had been on immunotherapy an average of 29 weeks (SD = 31.32). Roughly half had a high school degree or less (45%) and a household income of $25K/year or less (47%); 17% were on Medicaid. Most (77%) had an informal caregiver and were married (65%). Regarding financial hardship, 78% reported material costs (e.g., paying out of pocket for medications), 40% coping (e.g., reducing spending on leisure, cutting back on the basics), and 63% affect (e.g., worry about the family’s financial stability). Over half (52%) reported financial hardship in all three domains. Patients whose caregivers had made a change to employment (e.g., unpaid time off, work status) were more likely to report financial hardship in all three domains (55% vs. 28%, p = .03) and have more financial distress (Mean COST = 19.6 vs. 26.8, p = .01) compared to patients whose caregivers had not. Reducing spending on the basics was most strongly associated with financial distress (Mean COST = 12.7 for those who had reduced spending vs. 28.1 for those who had not, p <.001). Conclusions: Half of all patients undergoing immunotherapy for metastatic lung cancer may experience financial hardship in multiple domains. Asking patients if they have reduced spending on the basics or if their caregiver has had to make a change at work can help identify hardship.
Keywords: financial toxicity, immunotherapy, lung cancer, caregiver