Financial difficulty among patients with cancer participating in clinical trials and its association with patient survival and quality of life.

Abstract

The incidence and worsening of financial difficulty among patients with cancer participating in clinical trials and their relationship with mortality, quality of life, and toxicity outcomes have been understudied. The objective of this study was to understand the incidence of financial difficulty among Canadian patients participating in systemic therapy trials at baseline and after trial participation and to assess the relationship between financial difficulty and clinical outcomes. This retrospective cohort study included patients participating in 14 systemic therapy trials conducted by the Canadian Cancer Trials Group for adult patients with advanced cancer. Incidence of financial toxicity at baseline and after trial participation were measured using the European Organisation for Research and Treatment of Cancer QLQ Core Questionnaire. The association of financial difficulty with trial characteristics and patient outcomes (mortality, quality of life, and toxicity) was studied. Overall, 2766 patients from 14 trials were included, of whom 37% had financial difficulty at baseline and 25% experienced worsening of financial difficulty after trial enrollment compared with their baseline status. Baseline financial difficulty but not the worsening of financial difficulty was associated with worse mortality outcomes. Worsening of financial difficulty was, however, associated with poor global quality of life outcomes and increased odds of clinical toxicities. Even in the setting of a public health system in Canada, one-third of patients experience financial difficulty, with one-quarter of them experiencing worsening of financial difficulty with trial participation, and both were related to worse patient outcomes. Targeted policy-level interventions are needed to understand and address the cause of financial difficulty in patients with cancer.