Financial toxicity in cancer patients and subsequent risk of repeat acute care utilization

Julia J Shi; J Alberto Maldonado; Chi-Fang Wu; Susan K Peterson; Ying-Shiuan Chen; Kevin Diao; Robert J Volk; Sharon H Giordano; Ya-Chen T Shih; Kelsey Kaiser; Grace L Smith

doi:10.3389/fpsyg.2023.1209526

Financial toxicity in cancer patients and subsequent risk of repeat acute care utilization

Front Psychol. 2023 Aug 17:14:1209526. doi: 10.3389/fpsyg.2023.1209526. eCollection 2023.

Authors

Julia J Shi^#¹, J Alberto Maldonado^#^{1

2}, Chi-Fang Wu³, Susan K Peterson⁴, Ying-Shiuan Chen¹, Kevin Diao¹, Robert J Volk³, Sharon H Giordano³, Ya-Chen T Shih³, Kelsey Kaiser¹, Grace L Smith^{1

3}

Affiliations

¹ Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States.
² John Sealy School of Medicine, The University of Texas Medical Branch, Galveston, TX, United States.
³ Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, United States.
⁴ Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, United States.

^# Contributed equally.

Abstract

Background: Acute care (AC) visits by cancer patients are costly sources of healthcare resources and can exert a financial burden of oncology care both for individuals with cancer and healthcare systems. We sought to identify whether cancer patients who reported more severe initial financial toxicity (FT) burdens shouldered excess risks for acute care utilization.

Methods: In 225 adult patients who participated in the Economic Strain and Resilience in Cancer (ENRICh) survey study of individuals receiving ambulatory cancer care between March and September 2019, we measured the baseline FT (a multidimensional score of 0-10 indicating the least to most severe global, material, and coping FT burdens). All AC visits, including emergency department (ED) and unplanned hospital admissions, within 1-year follow-up were identified. The association between the severity of FT and the total number of AC visits was tested using Poisson regression models.

Results: A total of 18.6% (n = 42) of patients had any AC visit, comprising 64.3% hospital admissions and 35.7% ED visits. Global FT burden was associated with the risk of repeat AC visits within 1-year follow-up (RR = 1.17, 95% CI 1.07-1.29, P < 0.001 for every unit increase), even after adjusting for sociodemographic and disease covariates. When examining subdimensions of FT, the burden of depleted FT coping resources (coping FT) was strongly associated with the risk of repeat AC visits (RR = 1.27, 95% CI 1.15-1.40, P < 0.001) while material FT burden showed a trend toward association (RR = 1.07, 95% CI 0.99-1.15, P = 0.07).

Conclusion: In this prospective study of acute oncology care utilization outcomes among adult cancer patients, FT was a predictor of a higher burden of acute care visits. Patients with severely depleted material and also practical and social coping resources were at particular risk for repeated visits. Future studies are needed to identify whether early FT screening and intervention efforts may help to mitigate urgent acute care utilization burdens.

Keywords: acute care; cancer; emergency department; financial toxicity; screening.

Abstract

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