Patients with metastatic colorectal cancer who were below a certain level of income appear to be more likely to experience major financial hardship.
Major financial hardship occurred in 3 out of 4 patients with metastatic colorectal cancer, regardless of their health insurance status, according to the results of a multicenter cooperative group study published in the Journal of the National Cancer Institute.
At 12 months, the cumulative incidence of major financial difficulties was 71.3% (95% CI, 65.7%-76.1%). Patient characteristics such as age, race, marital status, and income sharing at $50,000 per year were not significantly associated with major financial hardship. However, those with income and/or total assets below $100,000 were associated with greater major financial hardship.
A total of 368 patients were eligible, of whom 73% were alive after 1 year of follow-up. Overall, 82.1% of patients achieved the primary endpoint or had an assessment at 12 months. The median age was 60.2 years and 62.8% of patients were under 65 years old. Additionally, 61.9% of patients were male and 13.0% were black. A total of 30.9% of patients had a total family income of $0 to $25,000, 25.5% earned $25,001 to $50,000, 14.7% earned $50,001 to $75,000, 8.4% earned between $75,001 and $100,000 and 17.7% earned more than $100,000. Most patients had private insurance (46.5%) while others had Medicare (38.9%), Medicaid (11.9%), another type (0.82%) or were not insured (1.9%). The patients were geographically distributed in the Midwest (47.3%), the South (23.1%), the West (20.4%) and the Northeast (9.2%). In the study, 19.8% of the patients came from rural areas.
The cumulative incidence of new debt at 12 months was 57.6% (95% CI, 51.7%-63.0%), 26.6% (95% CI, 21.3%-32, 0%) for a drop in income of 20% or more, 26.0% (95% CI, 21.5%-30.7%) for new loans from family and/or friends, 3.4% (95% CI, 1.7%-5.9%) for real estate refinancing and 2.6% (95% CI, 1.3%-4.7%) for the sale of a house. Major financial difficulties were generally reported early, with 24.9% (95% CI, 20.9% to 29.5%) experiencing difficulties at 3 months, 53.8% (95% CI, 48, 5% to 58.8%) at 6 months and 63.0% (95% CI, 57.8%-67.8%) at 9 months.
Patients who were unemployed had a statistically significantly lower likelihood of major financial hardship, but this was thought to be confounded with age, with older patients more likely to have larger assets and savings. Age below 65 was associated with a statistically significantly increased risk of major financial hardship (RR, 1.71; 95% CI, 1.06-2.75). Lower total assets were also significantly associated with a greater likelihood of major financial hardship at all total asset cut-off points.
At 3 months, patients with major financial difficulties were more likely to have lower European Organization for Research and Treatment of Cancer (EORTC) scores at 6 months. The analysis was adjusted for quality of life at 3 months, although only social functioning score and global health status score were statistically significant.
A sensitivity analysis indicated that the cumulative incidence of major financial hardship over 1 year was 43.0% (95% CI, 37.3% to 48.6%) after omitting the new debt measure. A total of 32.7% (95% CI, 27.8% to 37.7%) of patients had accumulated new debt at 1 year, and the pooled estimate of major financial hardship at 1 year was 58. 2% (95% CI, 52.5% to 63.6%).
A post hoc analysis indicated that for each increase, risk factors such as income below 100,000 that increased from 0 to 1 and from 1 to 2 resulted in a 49% increase in the risk of major financial hardship (RR, 1.49, 95% CI, 1.21-1.85; P <.001 at months the cumulative incidence of major financial difficulties was similar between owners ci and non-owners>
Shankaran V, Unger JM, Darke AK, et al. S1417CD: A Prospective, Multicenter, Cooperative, Group-Led Study of Financial Hardship in Patients with Metastatic Colorectal Cancer. J Natl Cancer Institute. 2022;114(3):372-380. doi:10.1093/jnci/djab210