|LETTERS TO EDITOR
|Year : 2021 | Volume
| Issue : 1 | Page : 170-171
One foot in the door: Financial toxicity in patients with cancer receiving active chemotherapy
Arpan A Patel
Division of Hematology Oncology, James P. Wilmot Cancer Institute, Strong Memorial Hospital, University of Rochester Medical Center, Rochester, NY, USA
|Date of Submission||24-Jan-2021|
|Date of Decision||12-Feb-2021|
|Date of Acceptance||01-Mar-2021|
|Date of Web Publication||26-Mar-2021|
Arpan A Patel
Division of Hematology Oncology, James P. Wilmot Cancer Institute, Strong Memorial Hospital, University of Rochester Medical Center, 601 Elmwood Avenue, Box 704, Rochester, NY 14642
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Patel AA. One foot in the door: Financial toxicity in patients with cancer receiving active chemotherapy. Cancer Res Stat Treat 2021;4:170-1
Financial toxicity (FT) is a major concern for patients with cancer receiving active chemotherapy. This aspect has recently received a lot of attention and research from the medical community, and rightly so. One reason for this is the rapidly increasing cost of oncology drugs. Goulart et al. reported that the high cost of drugs can lead to noncompliance with treatment, eventually worsening the quality of life (QOL) and reducing the overall survival of patients with lung cancer receiving oral targeted therapies. The lack of affordability of drugs can be a major hurdle in the treatment of a malignancy. Unfortunately, the actual cost of the drug is only one part of a very complex picture. There are several other aspects that need to be understood to effectively address the problem of FT in patients receiving cancer care; these include the indirect treatment costs, such as cost of transportation, loss of income from not being able to work, and lack of cost conversations between the patients and their providers.
Kalra et al. in their cross-sectional study on patients receiving systemic therapy for primary brain tumors assessed the perceived FT and QOL with the help of a questionnaire administered at a single time point during the treatment. They created and used a novel combination of two surveys: (i) the Financial Toxicity-Functional Assessment of Chronic Illness Therapy and (ii) Functional Assessment of Cancer Therapy-Brain to capture the FT and QOL of their patients. The authors observed that age, the category under which treatment was availed (regular or discounted), and disease status had a strong correlation with FT. The association between FT and disease outcomes has been reported for several cancer types, but there is a paucity of FT data related to the malignancies of the central nervous system. It can be difficult to take into account all the costs of cancer care, both direct and indirect, along with the patient-related variables when analyzing the FT. I commend Kalra et al. for taking the first step toward identifying the major contributors to FT in patients with cancer. One glaring point of difficulty is that the regression analysis showed an R2 value of 0.229; this means that 77.1% of the causes of FT experienced by the patients (as per the authors' definition) were not characterized by the added inputs. This is important as the current model only accounts for 22.9% of the causality of FT by patients, meaning further studies have to be done to find other inputs that may also lead to FT experienced by patients. Therefore, these data are not enough to predict who is at risk of experiencing FT and to eventually provide some interventions.
Future studies should include a more complex model to attain a higher R2 value to capture as many variables as possible to better explain the reasons for FT. This study is an excellent first step toward identifying who is at risk for FT among patients with primary brain tumors. The next steps could be to perform a more elegant regression analysis to correlate and analyze more variables to explain the other factors that can relate to FT. The final step would be to create an intervention to reduce the FT burden in the high-risk patients.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Polite BN, Ratain MJ, Lichter AS. Oncology's “Hockey Stick” moment for the cost of cancer drugs-The climate is about to change. JAMA Oncol 2021;7:25-6.
Goulart BH, Unger JM, Chennupati S, Fedorenko CR, Ramsey SD. Out-of-pocket costs for tyrosine kinase inhibitors and patient outcomes in EGFR
- and ALK
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Arastu A, Patel A, Mohile SG, Ciminelli J, Kaushik R, Wells M, et al
. Assessment of financial toxicity among older adults with advanced cancer. JAMA Netw Open 2020;3:e2025810.
Kalra D, Menon N, Singh GK, Dale O, Adak S, Das S, et al
. Financial toxicities in patients receiving systemic therapy for brain tumors: A cross-sectional study. Cancer Res Stat Treat 2020;3:724-9. [Full text]