The University of Toledo College of Medicine and Life Sciences, Department of Pediatrics, Toledo, OH
Michael Joseph Herriges Jr., Rachel Shenhav-Goldberg , Juliet Irene Peck , Oleg Shapiro , Joseph M Jacob , Alina Basnet , Gennady Bratslavsky , Hanan Goldberg
Background: The term ‘financial toxicity’ or ‘hardship’ is used to describe the financial problems patients experience due to high out-of-pocket costs for their healthcare. Financial toxicity in the context of cancer treatment is an area of recent study due to the significant costs associated with these treatments, but little is known about the effect of financial toxicity on cancer prevention. We examined the effects of financial toxicity on the utilization of screening tests for prevalent cancers, including prostate and colon cancer, using a US nationally representative survey-based data source. We hypothesized that patients with more financial hardship would show an association with decreased prevalence of prostate and colon cancer screening. Methods: This cross-sectional survey-based US study included men and women aged 18+ from the National Health Interview Survey (NHIS) database from January – December 2018. A financial hardship score between 0 and 1 was formulated by summarizing the responses from ten financial toxicity questions including if in the past 12 months one was unable to afford prescription medication or healthcare; or if one had to skip or take less medicine to save money. A higher score was associated with a worse financial hardship score. The primary outcomes of the study were self-reported occurrence of PSA blood testing for prostate cancer screening, and occurrence of colonoscopy for colon cancer screening. Results: As shown in table, a higher financial hardship score was associated with a decreased odds ratio for having a PSA test of 0.916 (95% CI 0.867-0.967, p=0.002) and colonoscopy of 0.969 (95% CI 0.941-0.998, p=0.039). Conclusions: Worse financial hardship is associated with a decreased probability of having PSA or colonoscopy screening tests. Awareness of this specific toxicity needs to be raised, examining the association of financial toxicity and screening of prostate, colon, and other additional cancers.
Had PSA Test | Had Colonoscopy | |||
---|---|---|---|---|
OR (95% CI) | P value | OR (95% CI) | P value | |
Age (Continuous) | 1.031 (1.020-1.042) | <0.001 | 1.032 (1.027-1.038) | <0.001 |
Gender (Male vs Female) | N/A | N/A | 1.124 (1.028-1.229) | 0.010 |
Working Status (Working vs Not Working) | 1.182 (0.994-1.405) | 0.058 | 0.939 (0.848-1.040) | 0.230 |
Marital Status (Spouse vs No Spouse) | 1.671 (1.435-1.946) | <0.001 | 1.414 (1.291-1.547) | <0.001 |
Financial Hardship Score (Continuous) | 0.916 (0.867-0.967) | 0.002 | 0.969 (0.941-0.998) | 0.039 |
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