Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Sep 3;7(9):e2431967.
doi: 10.1001/jamanetworkopen.2024.31967.

Financial Hardship Among Patients With Early-Stage Colorectal Cancer

Gelareh Sadigh  1 , Fenghai Duan  2   3 , Na An  3 , Ilana D Gareen  3   4 , JoRean Sicks  3 , Jennifer M Suga  5 , Heather Kehn  6 , Paul T Mehan  7 , Rajesh Bajaj  8 , David S Hanson  9 , Samir M Dalia  10 , Jared D Acoba  11 , Demet GoKalp Yasar  12 , Michael A Taylor  13 , Elyse Park  14 , Lynne I Wagner  15 , Sheetal M Kircher  16 , Ruth C Carlos  17
Affiliations

Financial Hardship Among Patients With Early-Stage Colorectal Cancer

Gelareh Sadigh et al. JAMA Netw Open. .

Abstract

Importance: The degree of cancer patients' financial hardship is dynamic and can change over time.

Objective: To assess longitudinal changes in financial hardship among patients with early-stage colorectal cancer.

Design, setting, and participants: In this prospective longitudinal cohort study, English-speaking adult patients with a new diagnosis of stage I to III colorectal cancer being treated with curative intent at National Cancer Institute (NCI) Community Oncology Research Program (NCORP) practices between May 2018 and July 2020 and who had not started chemotherapy and/or radiation were included. Data analysis was conducted from March to December 2023.

Main outcomes and measures: Patients completed surveys at baseline as well as at 3, 6, 12, and 24 months after enrollment. Cost-related care nonadherence and material hardship, as adopted by Medical Expenditure Panel Survey, were measured. Factors associated with financial hardship were assessed using longitudinal multivariable logistic regression models with time interaction.

Results: A total of 451 patients completed baseline questions, with 217 (48.1%) completing the 24-month follow-up. Mean (SD) age was 61.0 (12.0) years (210 [46.6%] female; 33 [7.3%] Black, 380 [84.3%] White, and 33 [7.3%] American Indian or Alaska Native, Asian, multiracial, or Native Hawaiian or Other Pacific Islander individuals or those who did not report race or who had unknown race). Among 217 patients with data at baseline and 24 months, 19 (8.8%) reported cost-related care nonadherence at baseline vs 20 (9.2%) at 24 months (P = .84), and 125 (57.6%) reported material hardship at baseline vs 76 (35.0%) at 24 months (P < .001). In multivariable analysis, lower financial worry (odds ratio [OR], 0.90; 95% CI, 0.87-0.93), higher education (OR, 0.34; 95% CI, 0.15-0.77), and older age (OR, 0.94; 95% CI, 0.91-0.98) were associated with lower nonadherence. Receipt of chemotherapy was associated with higher material hardship (OR, 2.68; 95% CI, 1.15-6.29), while lower financial worry was associated with lower material hardship (OR, 0.83; 95% CI, 0.80-0.96). Over 24 months, female sex was associated with lower nonadherence (OR, 0.90; 95% CI, 0.85-0.96), while higher education was associated with higher nonadherence (OR, 1.09; 95% CI, 1.03-1.17). Being employed was associated with lower material hardship (OR, 0.85; 95% CI, 0.78-0.93), while receipt of care at safety-net hospitals was associated with higher hardship (OR, 1.09; 95% CI, 1.01-1.17).

Conclusions and relevance: In patients with early-stage colorectal cancer, material hardship was more common than cost-related cancer care nonadherence and decreased over time, while nonadherence remained unchanged. Early and longitudinal financial screening and referral to intervention are recommended to mitigate financial hardship.

Trial registration: ClinicalTrials.gov NCT03516942.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest Disclosures: Dr Sadigh reported receiving grants from the National Cancer Institute (NCI) and honorarium from Journal of the American College of Radiology for serving as associated editor outside the submitted work. Dr Duan reported receiving grants from the National Institutes of Health (NIH)/NCI during the conduct of the study and personal fees from EarlyDiagnostics outside the submitted work. Dr Gareen reported receiving grants from the NCI during the conduct of the study and outside the submitted work. Dr Sicks reported receiving grants from the NCI during the conduct of the study. Dr Acoba reported receiving research support from GSK outside the submitted work. Dr Wagner reported receiving grants from the NCI during the conduct of the study and receiving personal fees from Celgene/Bristol Myers Squibb outside the submitted work. Dr Carlos reported receiving grants from ECOG-ACRIN during the conduct of the study as well as salary support from the Journal of the American College of Radiology for serving as editor in chief and personal fees from the Academy of Radiology and Biomedical Imaging Research, GE Radiology Research Academic Fellowship, American College of Radiology, Montefiore Medical Center, Emory University, New York State Radiological Society, University of North Carolina, and UT Southwestern Medical Center outside the submitted work. No other disclosures were reported.

Figures

Figure.
Figure.. Study Flow Diagram
See this image and copyright information in PMC

Comment in

References

    1. Zheng Z, Jemal A, Han X, et al. . Medical financial hardship among cancer survivors in the United States. Cancer. 2019;125(10):1737-1747. doi:10.1002/cncr.31913 - DOI - PubMed
    1. Altice CK, Banegas MP, Tucker-Seeley RD, Yabroff KR. Financial hardships experienced by cancer survivors: a systematic review. J Natl Cancer Inst. 2016;109(2):djw205. doi:10.1093/jnci/djw205 - DOI - PMC - PubMed
    1. Zafar SY, McNeil RB, Thomas CM, Lathan CS, Ayanian JZ, Provenzale D. Population-based assessment of cancer survivors’ financial burden and quality of life: a prospective cohort study. J Oncol Pract. 2015;11(2):145-150. doi:10.1200/JOP.2014.001542 - DOI - PMC - PubMed
    1. Lathan CS, Cronin A, Tucker-Seeley R, Zafar SY, Ayanian JZ, Schrag D. Association of financial strain with symptom burden and quality of life for patients with lung or colorectal cancer. J Clin Oncol. 2016;34(15):1732-1740. doi:10.1200/JCO.2015.63.2232 - DOI - PMC - PubMed
    1. Ramsey SD, Bansal A, Fedorenko CR, et al. . Financial insolvency as a risk factor for early mortality among patients with cancer. J Clin Oncol. 2016;34(9):980-986. doi:10.1200/JCO.2015.64.6620 - DOI - PMC - PubMed

Publication types

Associated data