Screening for Financial Toxicity Among Patients With Cancer: A Systematic Review

The Role of Social Support in Buffering the Financial Toxicity of Breast Cancer: A Qualitative Study of Patient Experiences

Background/Objectives: Financial distress from the direct and indirect costs of cancer treatment is a critical issue for many patients with breast cancer, particularly those from underserved populations who may be more vulnerable to financial hardship and its negative impacts on quality of life and clinical outcomes (i.e., financial toxicity). Few investigations, however, focus on protective factors that safeguard against financial toxicity. This study explores how social support might reduce financial toxicity among patients with breast cancer who are at high risk for financial hardship. Methods: We analyzed interviews with 41 adult women treated for stage I-IV breast cancer that had been conducted between December 2021 and March 2022. Our study specifically sampled women considered to be at elevated risk for financial toxicity: young adults aged 18-40 years old, Black women, women with lower incomes, and those residing in rural communities. We used deductive and inductive coding to identify themes related to social support. Results: Interviewees reported receiving support from family, friends, and their communities during their treatments. They noted how this social support helped with direct and indirect costs, encouraged emotional wellbeing, and safeguarded against economizing behaviors that offset spending (e.g., financial tradeoffs that jeopardize their treatment plan). Conclusions: Patients with breast cancer from groups vulnerable to financial toxicity often rely on the support of family, friends, and their communities to help buffer financial distress from the costs of treatment. These data highlight social support as an area for future studies exploring strategies to mitigate financial toxicity.

Suicide Risk in Digestive Cancer Patients: A Systematic Review of Sociodemographic, Psychological, and Clinical Predictors

A cancer diagnosis often triggers profound psychological and emotional distress as individuals reflect on existential issues such as life and death. The aim of this review was to provide estimates of suicide risk associated with digestive cancer worldwide, and to identify sociodemographic, psychological, and clinical factors associated with suicide risk in patients with digestive cancer.

MATERIALS AND METHODS

The literature search was guided by the following question: What is the relationship between suicide and digestive cancer, and what sociodemographic, psychological, and clinical factors contribute to the risk of suicide in these patients? We searched PubMed, PsycINFO, Embase, CINAHL, and Web of Science, and systematically reviewed the evidence, according to PRISMA guidelines, from relevant articles on the association between digestive system cancers and suicide outcomes published over a 14-year period (2011-2024). Eligible studies were searched in the main scientific databases up to August 2024.

RESULTS

There are many reasons why people die by suicide, including challenges faced by patients in mentally adapting to their new condition and physical illness. Studies have shown that the highest suicide rates in digestive cancer patients are observed in males, older age groups, single people, those with a poor cancer prognosis, and those with a lack of treatment provision (surgery or chemotherapy). The risk of suicide peaks at six months post-discrimination, remains stable for three years, and then declines.

CONCLUSIONS

Systematic changes in cancer care, such as aggressive treatment of pain and physical symptoms, management of delirium and cognitive impairment, routine screening, increased monitoring, and proactive measures for high-risk patients, can play a critical role in preventing unnecessary deaths and addressing the increased vulnerability of cancer patients, underscoring the need for targeted psychological support and early intervention, especially during critical periods like diagnosis and post-treatment recovery.

Survey of Health Care Providers on Social Determinants of Health and Treatment Decision-Making for Patients With HR+/HER2- Metastatic Breast Cancer

INTRODUCTION

Social determinants of health (SDOH) are a range of nonmedical factors that contribute to outcome disparities among certain groups of patients; however, little is known about how SDOH affect treatment decision-making for patients with cancer, particularly those with metastatic breast cancer (mBC). This study sought to gain insights from physicians and advanced practice providers on the impact of SDOH on practice- and patient-level cancer care decision-making with a nationwide online survey.

METHODS

The Social Determinants of Health in Metastatic Breast Cancer Survey was developed by the Association of Cancer Care Centers (ACCC) in partnership with Pfizer Inc, and in consultation with SDOH specialists. The 23-question survey captured experiences with SDOH-informed treatment decision-making for patients with cancer via multiple choice, Likert-scale, and free-response questions. ACCC-member physicians and advanced practice providers in the USA completed the survey between 23 January and 8 February 2024.

RESULTS

Respondents (n = 145), a majority of whom were medical oncologists (60%), represented clinics from diverse geographic regions of the USA; approximately 65% of respondents' clinics served patient populations with ≥ 10% Black, Indigenous, or People of Color. Common comprehensive cancer care services were provided by at least 59% of clinics, and SDOH factors were assessed by approximately 75% of clinics at diagnosis. Navigation services were available for patients with mBC at approximately 75% of respondents' clinics. Financial considerations (51%) and the presence of a caregiver (35%) were the most frequently cited SDOH-related factors that impacted mBC treatment decision-making.

CONCLUSION

The surveyed ACCC-member care providers displayed a high degree of awareness regarding SDOH impacts on their practice and patients, but resource limitations were identified as barriers to comprehensive, SDOH-informed cancer care. Harnessing existing resources from local and national advocacy groups, especially navigator training programs, is an actionable, real-world solution for improving mBC care for patients facing SDOH barriers.

Prevalence of Health-Related Social Needs and Associated Missed Imaging Appointments Among Patients With Cancer

PURPOSE

Health-related social needs (HRSNs) lead to health disparities and impact cancer care, but their link with missed imaging appointments in patients with cancer is unclear. We assessed screen rate and prevalance of HRSNs and their association with missed imaging appointments among patients with cancer.

METHODS

Patients aged ≥18 years with cancer who completed an oncology wellness form as part of usual care between January 1, 2022, and September 30, 2023, who had an imaging examination scheduled at the same health system within 3 months after form completion were included. The form assessed HRSNs (financial, transportation, and housing) and patients' preference for written or verbal information about HRSNs services. Multivariable regression models evaluated the association between HRSNs and missed imaging appointments.

RESULTS

In all, 3,495 (16.6%) of patients had a completed oncology wellness form during 3,964 (4.3%) encounters; of those, 2,890 had imaging scheduled in the next 3 months and were included (mean age: 61.6 ± 15.9 years; 50.2% female; 20.1% Asian, 2.8% Black, 57% White, 20.6% Hispanic). HRSNs were reported during 22.9% of encounters, with 82.9%, 40.2%, and 37.5% of reported HRSNs being due to financial hardship, transportation, and housing issues. Only 6.5% and 4.4% of encounters positive for HRSNs reported a desire for written information or to speak with someone about their HRSNs, respectively. At least one imaging encounter was missed by 70% in the subsequent 3 months. Adjusting for sociodemographic factors, patients reporting HRSNs were more likely to miss their imaging appointment (odds ratio, 1.29; 95% confidence interval, 1.03-1.61).

CONCLUSION

Patients with cancer with self-reported HRSNs tend to have higher missed imaging appointments.

Psychometric Properties of Self-Reported Financial Toxicity Measures in Cancer Survivors: An Overview of Systematic Reviews

AIM(S)

To assess the methodological quality and psychometric properties of self-reported financial toxicity measures for cancer survivors, to offer evidence-based guidance for the selection of these measures in clinical practice, and to supply methodological references for the enhancement and development of related measures in the future.

DESIGN

An overview of systematic reviews.

METHODS

Four academic databases were searched to conduct an overview of systematic reviews published from inception to August 2024. The Overview Quality Assessment Questionnaire (OQAQ) was employed to evaluate the methodological quality of the research included. The consensus-based standards for the selection of health measurement instruments checklist (COSMIN) and the Grades of Recommendation Assessment, Development, and Evaluation (GRADE) system were employed to assess the methodological and psychometric quality of the financial toxicity measures included.

RESULTS

Six systematic reviews satisfied the inclusion criteria. The OQAQ results indicated that six studies exhibited significant methodological quality defects, each receiving a score of 3 points. COST-v1, COST-v2, HARDS, ENRICh, and FinTox were classified as level A. Ten measures were classified as level B, lacking evidence to support content validity and internal consistency as '+'. Seven measures were classified at level C, supported by high-quality evidence indicating certain domains as '-'.

CONCLUSION

COST is advised as the best appropriate measurement standard for research and clinical practice across many global contexts. HARDS and ENRICh were advised to select only after thoroughly evaluating the local socio-economic context. FinTox is particularly suggested for the assessment of severe FT. SFDQ and FIT are advised for selection following an evaluation of therapy alternatives and the cancer's location.

IMPLICATIONS FOR THE PATIENT CARE

Healthcare professionals can implement evidence-based measures in clinical practice to effectively assess the financial toxicity experienced by cancer survivors, offer policy-oriented interventions, and enhance patient-reported outcomes.

Validation of a Single Item Measure for Financial Toxicity Screening in Patients With Breast Cancer

PURPOSE

Financial toxicity (FT) has been linked to higher symptom burden and poorer clinical outcomes for patients with cancer. Despite the availability of validated tools to measure FT, a simple screen remains an unmet need. We evaluated item 12 ("My illness has been a financial hardship to my family and me") of the COmprehensive Score for Financial Toxicity (COST) measure as a single-item FT screening measure.

METHODS

In this secondary analysis, 711 patients with cancer (690 with breast cancer) were recruited via a web-based survey from a philanthropic organization. COST items 1-11 were scored according to Functional Assessment of Chronic Illness Therapy scoring guidelines, with lower scores indicating worse FT. Analyses focused on establishing a correlation, examining item properties, and sensitivity/specificity of item 12 relative to the total COST score.

RESULTS

Item 12 had a correlation of r = 0.53 with the COST-11 score, and an increase of one point on item 12 is associated with a decrease of approximately three total points on the full scale (b, 3.35; P < .001; adjusted R2, 0.28). Item analysis with the graded-response item in response theory modeling showed very good discrimination (a, 2.096) for item 12, indicating that it can reliably distinguish between low and high FT in patients. Sensitivity ranged between 75.6% and 95.7% on all item 12 thresholds to screen positive for FT using two COST cutoffs as criteria. Maximizing both sensitivity and specificity was to be found for higher item 12 scores.

CONCLUSION

To our knowledge, this is the first validation of a single-item screening measure for FT. Overall, these results illustrate that item 12 from the COST measure is a good candidate for a single-item screener. Clinicians can choose among item 12 screening thresholds depending on their tolerance for low specificity.