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Correlates of financial toxicity in adult cancer patients and their informal caregivers

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Abstract

Background

Financial toxicity is commonly reported by cancer patients, but few studies have assessed caregiver perceptions. We aimed to validate the modified Comprehensive Score for Financial Toxicity (COST) in cancer caregivers, identify factors associated with financial toxicity in both patients and caregivers, and assess the association of caregiver financial toxicity with patient and caregiver outcomes.

Methods

Using a convenience sampling method, 100 dyads of adult cancer patients and a primary caregiver visiting outpatient oncology clinics (Jan–Sep 2019) were recruited. We assessed the internal consistency and convergent and divergent validity of the modified COST. Multivariable analyses identified correlates of financial toxicity. Association of financial toxicity with care non-adherence, lifestyle-altering behaviors (e.g., home refinance/sale, retirement/saving account withdrawal), and quality of life (QOL) was investigated.

Results

Recruited patient vs. caregiver characteristics were as follows: mean age: 60.6 vs. 56.5; 34% vs. 46.4% female; 79% vs. 81.4% white. The caregiver COST measure demonstrated high internal consistency (Cronbach α = 0.91). In patients, older age (B, 0.3 [95% CI, 0.1–0.4]) and higher annual household income (B, 14.3 [95% CI, 9.3–19.4]) correlated with lower financial toxicity (P < 0.05). In caregivers, lower patient financial toxicity (B, 0.4 [95% CI, 0.2–0.6]) and cancer stages 1–3 (compared to stage 4) (B, 4.6 [95% CI, 0.4–8.8]) correlated with lower financial toxicity (P < 0.05). Increased caregiver financial toxicity correlated with higher care non-adherence in patients, increased lifestyle-altering behaviors, and lower QOL in patients and caregivers (P < 0.05).

Conclusion

The COST measure can also be used to assess caregiver financial toxicity. Caregivers’ financial toxicity was associated with negative outcomes for both dyad members.

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Data availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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Acknowledgements

Assistance with data acquisition was provided by Debura Coleman, PhD, Emory University. This work has been supported in part by UG1CA189828 (Ruth C Carlos, MD) and the Biostatistics and Bioinformatics Shared Resource of Winship Cancer Institute of Emory University and NIH/NCI under award number P30CA138292 (Jeffrey Switchenko, PhD).

Funding

This study was funded by the General Electric-Association of University Radiologists Radiology Research Academic Fellowship (GERRAF).

Author information

Authors and Affiliations

  1. Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Rd, Suite BG20, Atlanta, GA, 30322, USA

    Gelareh Sadigh

  2. Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, USA

    Jeffrey Switchenko

  3. Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC, USA

    Kathryn E. Weaver

  4. Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, NC, USA

    Deema Elchoufi

  5. Department of Hematology and Oncology, Winship Cancer Institute of Emory University School of Medicine, Atlanta, GA, USA

    Jane Meisel, Mehmet Asim Bilen, David Lawson & Bassel El-Rayes

  6. Department of Medical Social Sciences, Northwestern University, Chicago, IL, USA

    David Cella

  7. Department of Radiology, University of Michigan, Ann Arbor, MI, USA

    Ruth Carlos

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  1. Gelareh Sadigh
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Corresponding author

Correspondence to Gelareh Sadigh.

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Ethics approval

The study was approved by Emory University Institutional Review Board (IRB approval # IRB00108258) and was Health Insurance Portability and Accountability Act (HIPAA) compliant.

Consent to participate

Written informed consent was obtained from all participants.

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Patients signed informed consent regarding publishing their data.

Conflict of interest

Dr. Sadigh received salary support from AUR GERRAF. Dr. Carlos receives salary support from the Journal of the American College of Radiology and research support from the Neiman Health Policy Institute. Dr. Bilen has acted as a paid consultant for and/or as a member of the advisory boards of Exelixis, Bayer, BMS, Eisai, Pfizer, AstraZeneca, Janssen, Genomic Health, Nektar, and Sanofi and has received grants to his institution from Xencor, Bayer, Bristol-Myers Squibb, Genentech/Roche, Seattle Genetics, Incyte, Nektar, AstraZeneca, Tricon Pharmaceuticals, Peleton Therapeutics, and Pfizer for work performed as outside of the current study. Dr. Meisel has acted as a member of the advisory boards of Pfizer and Puma and has received grants to her institution from Pfizer, Seattle Genetics, and Eli Lilly. Dr. Cella is the president of FACIT.ORG. Drs. Switchenko, Elchoufi, Lawson, Weaver, and El-Rayes do not report any conflict of interests.

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Sadigh, G., Switchenko, J., Weaver, K.E. et al. Correlates of financial toxicity in adult cancer patients and their informal caregivers. Support Care Cancer 30, 217–225 (2022). https://doi.org/10.1007/s00520-021-06424-1

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