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Do discussions of financial burdens decrease long-term financial toxicity in adolescent and young adult cancer survivors?

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Abstract

Purpose

This study aims to evaluate the associations between patient-provider cost discussions with patient-reported out-of-pocket (OOP) spending and long-term financial toxicity (FT) among adolescent and young adult (AYA; 15–39 years old) cancer survivors.

Methods

Using a cross-sectional survey, we assessed the themes and quality of patient discussions with providers about financial needs and general survivorship preparation, quantified patients’ levels of FT, and evaluated patient-reported OOP spending. We determined the association between cancer treatment cost discussion and FT using multivariable analysis. In a subset of survivors (n = 18), we conducted qualitative interviews and used thematic analysis to characterize responses.

Results

Two hundred forty-seven AYA survivors completed the survey at a mean of 7 years post treatment and with a median COST score of 13. 70% of AYA survivors did not recall having any cost discussion about their cancer treatment with a provider. Having any cost discussion with a provider was associated with decreased FT (β = 3.00; p = 0.02) but not associated with reduced OOP spending (χ2 = 3.77; p = 0.44). In a second adjusted model, with OOP spending included as a covariate, OOP spending was a significant predictor of FT (β =  − 1.40; p = 0.002). Key qualitative themes included survivors’ frustration about the lack of communication related to financial issues throughout treatment and in survivorship, feeling unprepared, and reluctance to seek help.

Conclusion

AYA patients are not fully informed about the costs of cancer care and FT; the dearth of cost discussions between patients and providers may represent a missed opportunity to reduce costs.

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Data availability

Data will be available upon request and proper approval.

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Funding

This analysis was supported by the following sources: Memorial Sloan Kettering’s Medical Student Summer Research Fellowship Program sponsored by NIH/NCI 5R25CA020449, the Chanel Endowment to Support Survivorship Research, and NIH/NCI Cancer Center Support Grant P30 CA008748.

Author information

Authors and Affiliations

  1. Case Western Reserve University School of Medicine, Cleveland, OH, USA

    Victoria S. Wu

  2. Stanford University School of Medicine, Stanford Cancer Institute, Palo Alto, CA, USA

    Catherine Benedict

  3. Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Danielle N. Friedman

  4. Expect Miracles Foundation, Boston, MA, USA

    Samantha E. Watson & Michelle S. Zeitler

  5. Rutgers New Jersey Medical School, Newark, NJ, USA

    Evanie Anglade

  6. Affordability Working Group, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Fumiko Chino & Bridgette Thom

  7. Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Fumiko Chino

  8. Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA

    Bridgette Thom

Authors
  1. Victoria S. Wu
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  2. Catherine Benedict
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  3. Danielle N. Friedman
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  4. Samantha E. Watson
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  5. Evanie Anglade
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  6. Michelle S. Zeitler
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  7. Fumiko Chino
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  8. Bridgette Thom
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Victoria Wu, Catherine Benedict, Fumiko Chino, and Bridgette Thom. The first draft of the manuscript was written by Victoria Wu, and all authors commented on subsequent versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Bridgette Thom.

Ethics declarations

Ethics approval

This study was conducted in accordance with the Declaration of Helsinki. This study was reviewed by the Memorial Sloan Kettering Institutional Review Board as exempt research.

Consent to participate

Because all data were collected anonymously, documented subject-specific was not sought; however, potential participants were informed about the voluntary nature of the study and that completing the survey implied consent.

Consent for publication

Participants were made aware that their responses were anonymous, that they could leave the study at any time, that their choice to participate would not impact any care they received, and that findings from the study may be shared through professional publications and presentations.

Competing interests

The authors declare no competing interests.

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Fumiko Chino and Bridgette Thom are the co-last authors.

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Wu, V.S., Benedict, C., Friedman, D.N. et al. Do discussions of financial burdens decrease long-term financial toxicity in adolescent and young adult cancer survivors?. Support Care Cancer 31, 434 (2023). https://doi.org/10.1007/s00520-023-07822-3

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