National Cancer Institute, Bethesda, MD
Michael T. Halpern , Reegan Kate Knowles , Carla Thamm , Raymond J Chan
Background: Financial Toxicity (FT), negative economic impacts resulting from cancer or cancer treatment, can adversely affect quality of life, treatment adherence, and clinical outcomes. Patient experience of care (EoC) captures information from patient’s perspectives on interactions with healthcare providers and systems and receipt of medical care services. While EoC is used to evaluate health care system and provider quality, the impacts of EoC on FT are unknown. Methods: To examine associations of EoC and FT, we used data from the from the 2016-2017 Experience of Cancer Survivorship Supplement of the Medical Expenditure Panel Survey (MEPS), the most recent years available of this national U.S. household survey. EoC was assessed using patient-reported frequencies (rated “never/sometimes”, “usually”, or “always”) of their health professionals explaining things in a way that was easy to understand; listening carefully; showing respect; and spending enough time with the patient in the past 12 months. FT was based on 9 MEPS items and classified as material FT (borrowing money, making financial sacrifices due to cancer), psychologic FT (worry about paying medical bills or financial stability), and behavioral FT (delaying/forgoing cancer care due to costs). Analyses were performed using multivariable logistic regressions controlling for patient sociodemographic and clinical characteristics and weighted to produce nationally representative estimates and address survey non-response. Results: Data included 1068 individuals diagnosed with cancer at age 18 or older; 30% reported material FT, 35% psychologic FT, and 27% behavioral FT. Examining EoC, 64% of respondents indicated their health professionals always explained things; 60% that they always listened; 66% that they always showed respect; and 57% that they always spent enough time with the patient. In multivariable regressions, the odds of psychologic FT were significantly (p<0.05) lower among patients reporting their health professionals always (vs. never/sometimes) listened (odds ratio [OR] 0.37, 95% CI 0.19-0.70), showed respect (OR 0.36, 95% CI 0.16-0.81), and spent enough time with the patient (OR 0.47, 95% CI 0.26-0.86). Significant associations with EoC were also found with individual psychologic FT questions from the MEPS on worry about paying bills, financial stability, and keeping job/income. Conclusions: Worry/anxiety regarding costs can be a major factor affecting individuals with cancer. Improving patient-provider interactions to enhance patient EoC may help reduce this aspect of FT.
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