C. J. LaRocca1, K. Lafaro1, A. Li3, K. Clark2, M. Loscalzo2, S. G. Warner1 1City of Hope National Medical Center,Department Of Surgery,Duarte, CA, USA 2City of Hope National Medical Center,Department Of Supportive Medicine,Duarte, CA, USA 3City of Hope National Medical Center,Department Of Information Sciences,Duarte, CA, USA
Introduction:
Biopsychosocial distress in cancer patients can negatively impact treatment compliance and prognosis. Understanding sources of distress and exploring possible interventions is part of comprehensive cancer care. This study uses a biopsychosocial distress screening tool to determine the factors associated with finance-related distress and the impact of these stressors on gastrointestinal cancer patients.
Methods:
A 48-question proprietary distress screening tool was administered to patients with gastrointestinal malignancies in medical and surgical oncology clinics from 2009-2015. This validated, electronically-administered tool is given to all new patients. Responses were recorded on a five-point Likert scale from 1 (not a problem) to 5 (very severe problem). Univariate and multivariate logistic regressions analyzed factors that impacted finance-related distress.
Results:
A total of 1027 patients participated in the study. Most patients had colorectal (50%) or hepatobiliary (31%) malignancies. The median age was 63. 52% of patients were male. 61% were Caucasian. 61% of patients did not complete college. 47% of patients reported an annual income of less than $40,000. 34% of all patients expressed a high level of finance-related distress. Patients with annual income greater than $40,000 reported that pain (OR=0.40, 95% CI=0.29-0.56), swelling (0.47, 0.30-0.74), and fatigue (0.62, 0.45-0.86) were less of a problem. Additionally, higher earners reported fewer issues with anxiety (0.66, 0.46-0.93), depression (0.40, 0.23-0.70), and difficulties managing emotions (0.51, 0.35-0.74). They were also less likely to report problems managing logistical and transportation issues (0.38, 0.25-0.56) and finding a community for support (0.32, 0.20-0.50). Increasing age, college education, being partnered, and high household income were all protective against finance-related distress on univariate logistic regression (Table 1).Tobacco abuse was also significantly associated with increased distress on univariate analysis (Table 1). On multivariate regression analysis, increasing age, completing college, and high income remained significantly protective against financial concerns, whereas tobacco abuse remained associated with increasing finance-related distress (Table 1).
Conclusion:
Higher income patients with gastrointestinal malignancies have significantly less biopsychological distress, especially with regards to anxiety, depression, pain, swelling, and fatigue. Protective factors for finance-related distress include older age, college education, and high income. Further study of at-risk populations may identify patients who would benefit from pre-emptive education and counseling interventions as part of their routine cancer care.
