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).
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This study was funded by the General Electric-Association of University Radiologists Radiology Research Academic Fellowship (GERRAF).
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The study was approved by Emory University Institutional Review Board (IRB approval # IRB00108258) and was Health Insurance Portability and Accountability Act (HIPAA) compliant.
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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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DOI: https://doi.org/10.1007/s00520-021-06424-1