Quality of Life Trajectories in Breast Cancer Patients Experiencing Financial Toxicity

Authors:

Jennifer Spencer (Presenter)
University of North Carolina at Chapel Hill

Laura Pinheiro, University of North Carolina at Chapel Hill
Katherine Reeder-Hayes, Lineberger Comprehensive Cancer Center
Lisa Carey, Lineberger Comprehensive Cancer Center
Andrew Olshan, University of North Carolina at Chapel Hill
Stephanie Wheeler, University of North Carolina at Chapel Hill

Public Health Statement: As the costs of cancer continue to rise, it is important to recognize the mental and emotional strain that financial burden can have on cancer patients and survivors- this study evaluates health-related quality of life changes associated with adverse financial outcomes after a cancer diagnosis.

Purpose: This study examines changes in quality of life (QoL) for women experiencing financial toxicity after cancer diagnosis using a racially diverse prospective cohort of women with breast cancer.

Methods/Approach: Health-related QoL was collected at approximately 5 and 25 months post-diagnosis using the Functional Assessment of Cancer Treatment (FACT-G). Women also reported on the financial impact of their breast cancer, including whether they had ever declined or delayed care due to cost or transportation barriers and whether they lost a job, experienced a reduction in household income, or lost insurance coverage after their cancer diagnosis. A difference in differences model was used to assess changes from 5 to 25 months by financial toxicity experience.

Results: 2,432 women completed both health-related quality of life surveys and were included in the analysis. 49% were non-Hispanic Black and 52% were non-Hispanic White. Overall, 49% of women reported experiencing at least one indicator of financial toxicity (59% Black vs. 39% White). Women who reported any financial toxicity had significantly lower scores on the FACT-G at baseline (75.48 vs 87.2, p<.001) and also experienced significantly less improvement from 5 to 25 months than women who did not report financial toxicity (1.4 vs 3.8, p=.01). Stratifying these results by race found that black women reported lower overall QoL than white women (p=.03), but the relationship between financial toxicity and QoL was not modified by race.

Conclusions/Implications: Financial toxicity is associated not only with reduced overall QoL, but with differential QoL trajectories following breast cancer diagnosis.