Association of self-reported financial burden with quality of life and oncologic outcomes in head and neck cancer.
Lenze Nicholas R,Bensen Jeannette T,Farnan Laura,Sheth Siddharth,Zevallos Jose P,Yarbrough Wendell G,Zanation Adam M
Head & neck
BACKGROUND:There is a paucity of data on financial toxicity among patients with head and neck squamous cell carcinoma (HNSCC). MATERIALS:This was a retrospective, cross-sectional study of patients with HNSCC surveyed at an outpatient oncology clinic. RESULTS:The sample included 202 patients with HNSCC with a mean age of 59.6 years (SD 10.0). There were 53 patients (26%) with self-reported financial burden. Education of high school or less was a significant predictor of self-reported financial burden (OR 2.52, 95% CI 1.03-6.14, p = 0.042). Patients reporting financial burden had significantly worse physical (p = 0.003), mental (p = 0.003), and functional (p = 0.036) health-related quality of life (HRQOL). Patients reporting financial burden appeared to have lower 5-year overall survival (74.3% vs. 83.9%, p = 0.165), but this association did not reach statistical significance. CONCLUSION:Financial burden or toxicity may affect approximately a quarter of patients with HNSCC and appears to be associated with worse HRQOL outcomes.
Association of significant financial burden with survival for head and neck cancer patients treated with radiation therapy.
Ma Sung Jun,Iovoli Austin J,Attwood Kristopher,Wooten Kimberly E,Arshad Hassan,Gupta Vishal,McSpadden Ryan P,Kuriakose Moni A,Markiewicz Michael R,Chan Jon M,Hicks Wesley L,Platek Mary E,Ray Andrew D,Repasky Elizabeth A,Farrugia Mark K,Singh Anurag K
OBJECTIVE:To assess the association between financial toxicity and survival in patients with head and neck cancer (HNC). MATERIALS AND METHODS:Using a single-institution database, we retrospectively reviewed HNC patients treated at Roswell Park Comprehensive Cancer Center treated with definitive or postoperative radiation therapy between 2013 and 2017. Kaplan-Meier method and log-rank tests were used to analyze survival outcomes. Propensity score matching on all clinically relevant baseline characteristics was performed to address selection bias. All statistical tests were two-sided and those less than 0.05 were considered statistically significant. RESULTS:Of a total of 284 HNC patients (age: median 61 years, IQR 55-67; 220 [77.5%] men), 204 patients (71.8%) received definitive radiation and 80 patients (28.2%) received adjuvant radiation. There were 41 patients (14.4%) who reported high baseline financial toxicity. Chemotherapy was used in 237 patients (83.5%). On multivariable analysis, those with high financial toxicity exhibited worse overall survival (hazards ratio [HR] 1.75, 95% confidence interval [CI] 1.05-2.94, p = 0.03) and cancer specific survival (HR 2.28, 95% CI 1.31-3.96, p = 0.003). On matched pair analysis of 66 patients, high financial toxicity remained associated with worse OS (HR 2.72, 95% CI 1.04-7.09, p = 0.04) and CSS (HR 3.75, 95% CI 1.22-11.5, p = 0.02). CONCLUSION:HNC patient reported baseline financial toxicity was significantly correlated with both decreased overall and cancer specific survival. These significant correlations held after match pairing. Further research is warranted to investigate the impact of financial toxicity in HNC and mitigate its risk.
Disadvantaged Subgroups Within the Global Head and Neck Cancer Population: How Can We Optimize Care?
American Society of Clinical Oncology educational book. American Society of Clinical Oncology. Annual Meeting
Within the global head and neck cancer population, there are subgroups of patients with poorer cancer outcomes independent from tumor characteristics. In this article, we review three such groups. The first group comprises patients with nasopharyngeal cancer in low- and middle-income countries where access to high-volume, well-resourced radiotherapy centers is limited. We discuss a recent study that is aiming to improve outcomes through the instigation of a comprehensive radiotherapy quality assurance program. The second group comprises patients with low socioeconomic status in a high-income country who experience substantial financial toxicity, defined as financial hardship for patients due to health care costs. We review causes and consequences of financial toxicity and discuss how it can be mitigated. The third group comprises older patients who may poorly tolerate and not benefit from intensive standard-of-care treatment. We discuss the role of geriatric assessment, particularly in relation to the use of chemotherapy. Through better recognition and understanding of disadvantaged groups within the global head and neck cancer population, we will be better placed to instigate the necessary changes to improve outcomes and quality of life for patients with head and neck cancer.