Despite access to Medicare in most cases, older patients with cancer remained deeply concerned about financial burdens from their medical care, a survey of almost 1,500 patients showed.
Financial hardship had a consistent and significantly negative impact on older patients’ health-related quality of life (HRQOL). Symptoms, disability, lack of emotional support, and other factors also emerged as factors affecting HRQOL, but many were consistent with findings from previous studies.
The emergence of financial issues as an influence on QOL came as a surprise, Maria Pisu, PhD, of the University of Alabama at Birmingham, and co-authors reported online in Cancer.
“What stood out to me was the finding that financial hardships affected the patients mental quality of life,” Pisu told MedPage Today. “We don’t usually think about that as being an issue for older adults. Previous studies have shown that financial issues are more relevant for the younger population of patients with cancer, so I was not expecting to see that.”
The survey included questions about financial “events,” such as having to borrow from savings to pay for care, having to take out loans, and having to declare bankruptcy. The more events a patient reported, the more closely financial hardship correlated with mental QOL, she said.
About a third of the patients were receiving active treatment at time of the survey, meaning that a majority of the study population had reached the survivorship stage of their care.
“We think this study emphasizes the need for ongoing assessment of symptoms, lack of social support, and other factors that potentially have long-term effects on older cancer patient’s quality of life,” said Pisu. “We encourage a holistic approach to the care of patients, which would include having discussions about the financial burdens or barriers associated with cancer.”
As the number of cancer survivors in the United States reached 15 million in 2016, the number of older people in that population continued to increase. Last year more 62% of cancer survivors were ≥65.
Older adults highly value traits associated with HRQOL, such as functional and cognitive well being and the ability to engage in leisure-time activities, Pisu and co-authors noted in the introduction to the study and its findings. Several studies have documented that older adults with cancer have poorer physical hr-QOL but similar mental HRQOL as compared with people of the same age without cancer.
Better understanding of the HRQOL factors that older cancer patients value most can help guide the development of useful interventions for a vulnerable patient population that continues to grow in number. Toward that end, Pisu and colleagues conducted a telephone survey of 1,457 older adults (≥65) to assess the impact of four life domains (physical, psychological, social, and spiritual) on HRQOL.
Eligible patients had cancer diagnoses after Jan. 1, 2008, and the surveys were administered by telephone during November 2013 to June 2015. Investigators assessed HRQOL by means of the Physical Component Summary (PCS) and Mental Component Summary (MCS) of the 12-item Short Form Survey. Possible scores ranged from 0 to 100, with higher scores representing better HRQOL. A score of 50 indicated HRQOL comparable to that of the general adult population in the U.S.
Investigators also used survey instruments to evaluate patients’ support needs, leisure time activities and exercise, symptoms, and financial hardships and challenges to accessing care.
The study population had a mean age of 74.2, women accounted for 60% of the study participants, and 62.9% of the survey respondents had a spouse or partner. The two most common types of cancer represented in the population were breast (23.7%), and prostate (13.0%). The participants had a mean PCS score of 42.3 and mean MCS score of 53.1.
The factors most closely associated with PCS score were symptom severity (adjusted R2=0.34) and physical support needs (aR2=0.16). Factors strongly associated with MCS score were symptom severity (aR2=0.32) and number of financial hardships (aR2=0.15). The relative importance of individual factors remained consistent across several different approaches to statistical modeling, the authors reported.
Fatigue, pain, disturbed sleep, and drowsiness were the symptoms most closely associated with PCS scores (aR2≥0.16). Fatigue, memory problems, disturbed sleep, and lack of appetite had the strongest associations with MCS score (aR2≥0.16).
“The results of the current study support the importance of quality comorbidity and supportive care, and of leisure-time physical activity interventions to address persistent symptoms such as pain, fatigue, and disturbed sleep,” the authors concluded. “Moreover, the results presented herein emphasize the need to address financial challenges that older cancer patients and survivors face.
“Overall, the results of the current study highlight the importance of a long-term comprehensive approach to managing the well-being of older adults with cancer.”
The study was funded by Genentech, which participated in interpreting study results and manuscript preparation. Some co-authors were Genentech employees. Pisu declared no other financial interests.
F. Perry Wilson, MD, MSCE Assistant Professor, Section of Nephrology, Yale School of Medicine and Dorothy Caputo, MA, BSN, RN, Nurse Planner