Financial toxicity and psychological distress in adults with cancer: A treatment-based analysis

Huihui Yu; Hui Li; Tingting Zuo; Li Cao; Xue Bi; Haiyang Xing; Lijuan Cai; Jianmin Sun; Yunyong Liu

doi:10.1016/j.apjon.2022.04.008

Financial toxicity and psychological distress in adults with cancer: A treatment-based analysis

Asia Pac J Oncol Nurs. 2022 Apr 20;9(9):100069. doi: 10.1016/j.apjon.2022.04.008. eCollection 2022 Sep.

Authors

Huihui Yu¹, Hui Li², Tingting Zuo¹, Li Cao², Xue Bi¹, Haiyang Xing², Lijuan Cai³, Jianmin Sun⁴, Yunyong Liu^{1

5}

Affiliations

¹ Liaoning Office for Cancer Control and Research, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Shenyang, China.
² Department of Nursing, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Shenyang, China.
³ Department of Cancer Prevention and Treatment, Fushun Cancer Hospital, Fourth Hospital of Fushun, Fushun, China.
⁴ Department of Cancer Prevention and Treatment, Anshan Cancer Hospital, Anshan, China.
⁵ National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China.

Abstract

Objective: To evaluate disparities in financial toxicity and psychological distress in patients with cancer as a function of treatment and reveal the relationship between financial toxicity and psychological distress.

Methods: This was a multicenter cross-sectional study. Patients were recruited from March 2017 to October 2018, and questionnaires were completed regarding their demographics, financial toxicity, and psychological distress. A multiple linear regression model was used to examine factors associated with financial and psychological distress.

Results: Significant financial toxicity and psychological distress occurred in 47.9% and 56.5% of patients, respectively. Financial toxicity (P = 0.032) and psychological distress (P < 0.001) were statistically different among the single chemotherapy, adjuvant therapy, and surgery groups. Multivariable analysis revealed that patients aged 50-59 years (P = 0.035), 60-69 years (P = 0.007), and 70 years or older (P = 0.002) had higher the Comprehensive Score for financial Toxicity (COST) scores compared with patients less than 50 years old. Patients with personal annual income > 40,000 CNY reported higher COST scores than those who had < 20,000 CNY (P < 0.001). Patients who had Urban Resident Basic Medical Insurance (URBMI) (P = 0.030) or New Rural Cooperative Medical Scheme (NRCMS) (P = 0.006) compared with Urban Employee Basic Medical Insurance (UEBMI) presented lower COST scores than patients with UEBMI. The multiple analysis model of psychological distress showed that an age of more than 70 years (P = 0.010) was significantly associated with low the Distress Thermometer (DT) scores, and patients with colorectal cancer (P = 0.009), the surgery group (P < 0.001) and adjuvant therapy group (P < 0.001) were significantly associated with high DT scores. The correlations between financial toxicity and psychological distress were mild but statistically significant in the chemotherapy-related treatment groups.

Conclusions: The research highlights the high rates of financial and psychological distress in adult patients. Multidimensional distress screening and psychosocial interventions should be provided for patients with cancer according to related factors.

Keywords: Cancer; Chemotherapy; Financial toxicity; Psychological distress; Surgery.