About one in five older cancer patients report experiencing financial toxicity, according to researchers from the University of Rochester in New York. In a large cohort of more than 500 patients aged 70 years and older, 18% stated they were experiencing financial problems related to the cost of their treatment and that this was taking a toll on their care, quality of life, and mental well-being.

Compared with those not experiencing financial issues, patients reporting financial toxicity had a higher prevalence of severe anxiety (18% vs. 7%) and depression (27% vs. 21%), as well as a poorer quality of life (41% vs. 22%).

The study also found that many older patients report delaying taking medication and are unable to afford their basic needs, explained lead author Asad Arastu, MSc, a medical student at the University of Rochester.

"Patients said that they were unable to afford medication and also had problems like the need to take time off work, not being able to afford gas, and cost concerns in other domains," he told. "There are a lot of missed opportunities, as patients have these concerns and they are not being discussed."

The findings will be presented at the American Society of Clinical Oncology (ASCO) Quality Care Symposium 2018. The study is a secondary analysis of baseline data from a geriatric assessment intervention study that was conducted across 31 practice sites.

Well-Established "Side Effect" of Cancer Therapy 

Financial toxicity has become a well-established "side effect" of cancer care, with many patients experiencing varying levels of distress related to the cost of their care.

However, financial toxicity is a subjective measure without a standard definition, Arastu commented. To measure the impact of financial toxicity on cancer patients in their study, the team developed an easy-to-use screening measure for cancer patients based on the current literature.

Patients were categorized as experiencing financial toxicity if they answered yes to any of three questions:

1. Have you ever delayed medications because of the cost?

2. Have you ever had insufficient income in a typical month for food or housing?

3. Have you ever had insufficient income in a typical month for other basic needs?

Greater Severity of Mental Health Issues

Patients were categorized as experiencing financial toxicity if they reported delaying medications because of cost, insufficient income in a typical month for food and housing, or insufficient income in a typical month for other basic needs.

Additionally, patients also completed the Generalized Anxiety Disorder-7 (GAD7, score 0–21) questionnaire to evaluate anxiety, Geriatric Depression Scale (GDS, score 0–15) to assess depression, and Functional Assessment of Cancer Therapy-Generation (FACT-G, score 0–108), to measure the overall quality of life.