April 25, 2019

Financial toxicity — the state when financial burden is a source of harm to individual patients — is burdensome for advanced- and metastatic-cancer patients in ways that may differ from earlier-stage patients, according to new research from the UNC Gillings School of Global Public Health.

Dr. Stephanie Wheeler

Dr. Stephanie Wheeler

Jason Rotter, PhD, a recent doctoral graduate of the Department of Health Policy and Management at the Gillings School, is lead author of “Financial Toxicity in Advanced and Metastatic Cancer: Overburdened and Underprepared,” published in the April 2019 issue of the Journal of Oncology Practice. Stephanie Wheeler, PhD, associate professor in the Department of Health Policy and Management, is a co-author.

Financial toxicity, or high financial burden from cancer care, has been linked to lower quality of life, higher emotional distress, delays or discontinuations of treatment, and increased mortality. The review findings suggest that people living with advanced cancer are uniquely vulnerable to financial toxicity and hardship as a result of their diagnosis, including an inability to pay for care, going into debt, lost wages, filing for bankruptcy, or making other major changes to household spending.

“Medical costs exceed patient ability to pay in many settings, but cancer is among the most acute and visible,” said Rotter. “Though we’ve seen incredible advancement in the treatment and management of various tumor types, not all patients have been able to experience these gains. Very little has been written about how metastatic patients cope with financial strain, both because they are a smaller subgroup of all cancer survivors, and because patients and caregivers often rightly focus more on treatment and disease management.”

Wheeler said that the added accumulated financial burden of advanced cancer is almost unbearable for some patients and families. Advanced cancer is resource-intensive with advanced (and expensive) treatments and more time spent in care settings, including inpatient, long-term care and hospice. Metastatic disease also is disproportionately diagnosed among underserved populations, including racial/ethnic minority and low-income populations.

“The high cost of ongoing cancer care for people living with metastatic disease affects patients’ psychosocial health, household financial security, and health outcomes when patients are forced to make difficult decisions about cost and benefit trade-offs,” Wheeler said.

Rotter added that researchers have been writing about financial burden and financial toxicity for more than a decade, but close to half of patients still report financial strain as a result of cancer care and diagnosis. This review makes the case for rigorous population-based studies to inform large-scale policy making and intervention development and implementation.

“Our hope is that researchers and policy makers would use this line of thinking in designing interventions that support patients experiencing financial burden,” he said. “This review can be an intellectual building block on which future research can begin to explore this population in more detail.”


Contact the Gillings School of Global Public Health communications team at sphcomm@listserv.unc.edu.

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