Background: Despite improved survival with chemotherapy for stage III colorectal cancer (CRC), patients may suffer substantial economic hardship during treatment. Methods for quantifying financial burden in CRC patients are lacking.
Objective: To derive and validate a novel patient-reported measure of personal financial burden during CRC treatment.
Data Collection: Within a population-based survey of patients in the Detroit and Georgia Surveillance, Epidemiology and End Results regions diagnosed with stage III CRC between 2011 and 2013, we asked 7 binary questions assessing effects of disease and treatment on personal finances.
Data Analysis: We used factor analysis to compute a composite measure of financial burden. We used χ2 tests to evaluate relationships between individual components of financial burden and chemotherapy use with χ2 analyses. We used Mantel-Haenszel χ2 trend tests to examine relationships between the composite financial burden metric and chemotherapy use.
Results: Among 956 patient surveys (66% response rate), factor analysis of 7 burden items yielded a single-factor solution. Factor loadings of 6 items were >0.4; these were included in the composite score. Internal consistency was high (Cronbach α=0.79). The mean financial burden score among all respondents was 1.72 (range, 0–6). The 812 (85%) who reported chemotherapy use had significantly higher financial burden scores than those who did not (mean burden score 1.88 vs. 0.88, P<0.001).
Conclusions: Financial burden is high among CRC patients, particularly those who use adjuvant chemotherapy. We encourage use of our instrument to validate our measure in the identification of patients in need of additional financial support during treatment.
*Department of Internal Medicine, Division of Hematology/Oncology
†Department of Surgery, Division of Colorectal Surgery, Center for Healthcare Outcomes and Policy
‡Division of General Medicine, Cancer Surveillance and Outcomes Research Team
§Department of Internal Medicine, Division of Hematology/Oncology, Center for Healthcare Outcomes and Policy, Cancer Surveillance and Outcomes Research Team
∥Department of Biostatistics, Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor
¶Department of Pathology, Wayne State University, Detroit, MI
#Department of Epidemiology, Georgia Center for Cancer Statistics, Rollins School of Public Health, Emory University, Atlanta, GA
**Department of Surgery, Division of Colorectal Surgery, Center for Healthcare Outcomes and Policy, Cancer Surveillance and Outcomes Research Team, University of Michigan, Ann Arbor, MI
A.M.M. and the study are supported by a generous Grant from the American Cancer Society, Atlanta, GA (Research Scholar Grant #11-097-01-CPHPS). The views expressed herein do not necessarily represent the views of the American Cancer Society.
The authors declare no conflict of interest.
Reprints: Arden M. Morris, MD, MPH, Department of Surgery, Center for Health Outcomes and Policy, University of Michigan, 1500 E Medical Center Dr, 2124F, Ann Arbor, MI 48109-5343. E-mail: email@example.com.