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Financial toxicity among people with metastatic cancer: findings from the Cancer Experience Registry

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Abstract

Purpose

This study describes financial toxicity (FT) reported by people with metastatic cancer, characteristics associated with FT, and associations between FT and compensatory strategies to offset costs.

Methods

Cancer Support Community’s Cancer Experience Registry data was used to identify respondents with a solid tumor metastatic cancer who completed the Functional Assessment of Chronic Illness Therapy COmprehensive Score for Financial Toxicity (FACIT-COST) measure. Multivariable logistic regression analyses examined associations between respondent characteristics and FT, and FT and postponing medical visits, nonadherence to medications, and postponing supportive and/or psychosocial care.

Results

484 individuals were included in the analysis; the most common cancers included metastatic breast (31%), lung (13%), gynecologic (10%), and colorectal (9%). Approximately half of participants (50.2%) reported some degree of FT. Those who were non-Hispanic White, Hispanic, or multiple races (compared to non-Hispanic Black), and who reported lower income, less education, and being less than one year since their cancer diagnosis had greater odds of reporting FT. Individuals with any level of FT were also more likely to report postponing medical visits (Adjusted Odds Ratio [OR] 2.58; 95% Confidence Interval [CI] 1.45–4.58), suboptimal medication adherence (Adjusted OR 5.05; 95% CI 2.77–9.20) and postponing supportive care and/or psychosocial support services (Adjusted OR 4.16; 95% CI 2.53–6.85) compared to those without FT.

Conclusions

With increases in the number of people living longer with metastatic cancer and the rising costs of therapy, there will continue to be a need to systematically screen and intervene to prevent and mitigate FT for these survivors.

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Data availability

The datasets analyzed during the current study are available from the corresponding author on reasonable request.

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Funding

Funding for the Cancer Experience Registry was provided by AbbVie, Amgen, AstraZeneca, Bristol-Myers Squibb, Celgene, Eli Lilly and Company, EMD Serono, Genentech (a member of the Roche Group), GlaxoSmithKline, Janssen Pharmaceuticals, Jazz Pharmaceuticals, Novartis, Pfizer, Pharmacyclics, Seagen, and Takeda Pharmaceutical.

Author information

Author notes

  1. Alexandra K. Zaleta

    Present address: Cancer Care, New York, NY, USA

Authors and Affiliations

  1. Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA

    Michelle A. Mollica, Lisa Gallicchio, Rachelle Brick, Paul B. Jacobsen, Emily Tonorezos & Kathleen M. Castro

  2. Research and Training Institute, Cancer Support Community, Washington, DC, USA

    Alexandra K. Zaleta & Melissa F. Miller

Authors
  1. Michelle A. Mollica
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Contributions

MAM, AZ, LG, KC, RB, ET, PJ, MM were responsible for research conceptualization; MM conducted the analyses; MAM and MM wrote the main manuscript text in collaboration with all authors; All authors reviewed the study design, results, and the manuscript.

Corresponding author

Correspondence to Melissa F. Miller.

Ethics declarations

Ethics approval

Ethical and Independent Review Services (E&I, Independence, MO) served as the IRB of record (Study #16036). All procedures were in accordance with the ethical standards of the institutional research committee for studies involving human participants and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all participants.

Consent to publish

The authors affirm that human research participants provided informed consent for publication of the data in all tables.

Disclaimers

The article was prepared as part of some of the authors’ (MAM, LG, PJ, ET, KC) official duties as employees of the US Federal Government. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the National Cancer Institute.

This study has not been previously presented.

Competing interests

The authors report the following conflicts of interest. Institutional research support was granted to the Cancer Support Community and not individual study authors:

Dr. Zaleta: Institutional research funding from: Astellas Pharma, Boston Scientific Foundation, Gilead Sciences, Novartis, Pfizer, Seagen.

Dr. Miller: Institutional research funding from: Astellas Pharma, BeiGene, Bristol-Myers Squibb, Genentech (a member of the Roche Group), Geron, Gilead Sciences, GlaxoSmithKline, Janssen Pharmaceuticals, Merck, Novartis, Pfizer, Taiho Oncology, and Takeda Pharmaceutical Company.

Drs. Mollica, Gallicchio, Brick, Jacobsen, Tonorezos, and Ms. Castro do not report any conflicts of interest.

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Mollica, M.A., Zaleta, A.K., Gallicchio, L. et al. Financial toxicity among people with metastatic cancer: findings from the Cancer Experience Registry. Support Care Cancer 32, 137 (2024). https://doi.org/10.1007/s00520-024-08328-2

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