A composite measure of personal financial burden among patients with stage III colorectal cancer

Abstract

Background: Despite improved survival with chemotherapy for stage III colorectal cancer (CRC), patients may suffer substantial economic hardship during treatment. Methods for quantifying financial burden in CRC patients are lacking.

Objective: To derive and validate a novel patient-reported measure of personal financial burden during CRC treatment.

Data collection: Within a population-based survey of patients in the Detroit and Georgia Surveillance, Epidemiology and End Results regions diagnosed with stage III CRC between 2011 and 2013, we asked 7 binary questions assessing effects of disease and treatment on personal finances.

Data analysis: We used factor analysis to compute a composite measure of financial burden. We used χ tests to evaluate relationships between individual components of financial burden and chemotherapy use with χ analyses. We used Mantel-Haenszel χ trend tests to examine relationships between the composite financial burden metric and chemotherapy use.

Results: Among 956 patient surveys (66% response rate), factor analysis of 7 burden items yielded a single-factor solution. Factor loadings of 6 items were >0.4; these were included in the composite score. Internal consistency was high (Cronbach α=0.79). The mean financial burden score among all respondents was 1.72 (range, 0-6). The 812 (85%) who reported chemotherapy use had significantly higher financial burden scores than those who did not (mean burden score 1.88 vs. 0.88, P<0.001).

Conclusions: Financial burden is high among CRC patients, particularly those who use adjuvant chemotherapy. We encourage use of our instrument to validate our measure in the identification of patients in need of additional financial support during treatment.

FIGURE 1

Patient report of individual personal financial burden items, by chemotherapy use. Those using chemotherapy were significantly more likely to endorse each item of financial burden (all P < 0.01).

FIGURE 2

Distribution of personal financial burden scores, by chemotherapy use. Those using chemotherapy had significantly higher scores and were less likely to report none of the items of personal financial burden (P < 0.001).