Leila J Mady1, Lingyun Lyu2, Maryanna S Owoc3, Shyamal D Peddada2, Teresa H Thomas4, Lindsay M Sabik5, Jonas T Johnson3, Marci L Nilsen6. 1. Department of Otolaryngology - Head and Neck Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States. Electronic address: madylj@upmc.edu. 2. Department of Biostatistics, University of Pittsburgh School of Public Health, Pittsburgh, PA, United States. 3. Department of Otolaryngology - Head and Neck Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States. 4. Department of Health Promotion and Development, University of Pittsburgh School of Nursing, Pittsburgh, PA, United States. 5. Department of Health Policy and Management, University of Pittsburgh School of Public Health, Pittsburgh, PA, United States. 6. Department of Otolaryngology - Head and Neck Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States; Department of Acute and Tertiary Care, University of Pittsburgh School of Nursing, Pittsburgh, PA, United States.
Abstract
OBJECTIVES: (1) Describe financial toxicity (FT) in head and neck cancer (HNC) survivors and assess its association with personal/health characteristics and health-related quality of life (HRQOL); (2) examine financial coping mechanisms (savings/loans); (3) assess relationship between COmprehensive Score for financial Toxicity (COST) and Financial Distress Questionnaire (FDQ). PATIENTS AND METHODS: Cross-sectional survey from January - April 2018 of insured patients at a tertiary multidisciplinary HNC survivorship clinic who completed primary treatment for squamous cell carcinoma of the oral cavity, oropharynx, or larynx/hypopharynx. RESULTS: Of 104 survivors, 30 (40.5%) demonstrated high FT. Patients with worse FT were more likely (1) not married (COST, 25.33 ± 1.87 vs. 30.61 ± 1.34, p = 0.008); (2) of lower education levels (COST, 26.12 ± 1.47 vs. 34.14 ± 1.47, p < 0.001); and (3) with larynx/hypopharynx primaries (COST, 22.86 ± 2.28 vs. 30.27 ± 1.50 vs. 32.72 ± 1.98, p = 0.005). Younger age (4.23, 95%CI 2.20 to 6.26, p < 0.001), lower earnings at diagnosis (1.17, 95%CI 0.76 to 1.58, p < 0.001), and loss in earnings (-1.80, 95%CI -2.43 to -1.16, p < 0.001) were associated with worse FT. COST was associated with HRQOL (0.08, p = 0.03). Most survivors (63/102, 60%) reported using savings and/or loans. Worse FT was associated with increased likelihood of using more mechanisms (COST, OR1.06, 95%CI 1.02 to 1.10, p = 0.004). Similar results were found with FDQ. CONCLUSIONS: We found differences in FT by primary site, with worst FT in larynx/hypopharynx patients. This finding illuminates potential site-specific factors, e.g. workplace discrimination or inability to return to work, that may contribute to increased risk. FDQ correlates strongly with COST, encouraging further exploration as a clinically-meaningful screening tool.
OBJECTIVES: (1) Describe financial toxicity (FT) in head and neck cancer (HNC) survivors and assess its association with personal/health characteristics and health-related quality of life (HRQOL); (2) examine financial coping mechanisms (savings/loans); (3) assess relationship between COmprehensive Score for financial Toxicity (COST) and Financial Distress Questionnaire (FDQ). PATIENTS AND METHODS: Cross-sectional survey from January - April 2018 of insured patients at a tertiary multidisciplinary HNC survivorship clinic who completed primary treatment for squamous cell carcinoma of the oral cavity, oropharynx, or larynx/hypopharynx. RESULTS: Of 104 survivors, 30 (40.5%) demonstrated high FT. Patients with worse FT were more likely (1) not married (COST, 25.33 ± 1.87 vs. 30.61 ± 1.34, p = 0.008); (2) of lower education levels (COST, 26.12 ± 1.47 vs. 34.14 ± 1.47, p < 0.001); and (3) with larynx/hypopharynx primaries (COST, 22.86 ± 2.28 vs. 30.27 ± 1.50 vs. 32.72 ± 1.98, p = 0.005). Younger age (4.23, 95%CI 2.20 to 6.26, p < 0.001), lower earnings at diagnosis (1.17, 95%CI 0.76 to 1.58, p < 0.001), and loss in earnings (-1.80, 95%CI -2.43 to -1.16, p < 0.001) were associated with worse FT. COST was associated with HRQOL (0.08, p = 0.03). Most survivors (63/102, 60%) reported using savings and/or loans. Worse FT was associated with increased likelihood of using more mechanisms (COST, OR1.06, 95%CI 1.02 to 1.10, p = 0.004). Similar results were found with FDQ. CONCLUSIONS: We found differences in FT by primary site, with worst FT in larynx/hypopharynx patients. This finding illuminates potential site-specific factors, e.g. workplace discrimination or inability to return to work, that may contribute to increased risk. FDQ correlates strongly with COST, encouraging further exploration as a clinically-meaningful screening tool.
Keywords:
Cost sharing; Head and neck cancer; Health expenditures; Health services; Health-related quality of life; Multidisciplinary research; Out-of-pocket expenses; Patient reported outcomes; Survivorship; Treatment costs
Authors: Marques S N Ng; Kai Chow Choi; Dorothy N S Chan; Cho Lee Wong; Weijie Xing; Pui Shan Ho; Cecilia Au; Mandy Chan; Man Tong; Wai Man Ling; Maggie Chan; Suzanne S S Mak; Raymond J Chan; Winnie K W So Journal: Support Care Cancer Date: 2021-04-02 Impact factor: 3.603
Authors: Joaquin E Jimenez; Marci Lee Nilsen; William E Gooding; Jennifer L Anderson; Nayel I Khan; Leila J Mady; Tamara Wasserman-Wincko; Umamaheswar Duvvuri; Seungwon Kim; Robert L Ferris; Mario G Solari; Mark W Kubik; Jonas T Johnson; Shaum Sridharan Journal: Oral Oncol Date: 2021-10-26 Impact factor: 5.337
Authors: Marci Lee Nilsen; David A Clump; Mark Kubik; Karen Losego; Alyssa Mrozek; Elizabeth Pawlowicz; Debra Pickford; Shaum Sridharan; Katie Traylor; Tamara Wasserman-Wincko; Kelly Young; Dan Zandberg; Jonas T Johnson Journal: Head Neck Date: 2020-05-18 Impact factor: 3.147
Authors: Khalil Baddour; Lauren D Kudrick; Aakriti Neopaney; Lindsay M Sabik; Shyamal D Peddada; Marci L Nilsen; Jonas T Johnson; Robert L Ferris; Leila J Mady Journal: Head Neck Date: 2020-04-28 Impact factor: 3.147
Authors: Khalil Baddour; Mark Fadel; Meng Zhao; Michael Corcoran; Maryanna S Owoc; Teresa H Thomas; Lindsay M Sabik; Marci L Nilsen; Robert L Ferris; Leila J Mady Journal: Head Neck Date: 2021-07-08 Impact factor: 3.821
Authors: Alexandria Harris; Jinhong Li; Karley Atchison; Christine Harrison; Daniel Hall; Tyler VanderWeele; Jonas T Johnson; Marci L Nilsen Journal: Cancer Med Date: 2022-03-11 Impact factor: 4.711
Authors: Mary C Politi; Renata W Yen; Glyn Elwyn; A James O'Malley; Catherine H Saunders; Danielle Schubbe; Rachel Forcino; Marie-Anne Durand Journal: Oncologist Date: 2020-10-12