Abstract A51: Financial and psychosocial impacts of adjuvant chemotherapy in older colorectal cancer patients: Differences by income
Authors: Weiss Elisa S. , Elkin Elena , Hamilton Amy , Patel Shilpa , Temple Larissa K. 
Published: December 2010

Introduction: Colorectal cancer (CRC) is the third most prevalent cancer in the U.S. The median age at CRC diagnosis is 71, making it the highest of the common cancer types. CRC treatment is among the most costly ($20,000-$30,000 for eight weeks of treatment), and even individuals with Medicare may incur substantial out-of-pocket expenses. Out-of-pocket costs, however small, can pose financial hardship to Medicare beneficiaries living on fixed incomes, especially those who are poor or marginally poor. In circumstances of financial stress and unmet needs, cancer treatment, recovery, and quality of life may be compromised. This exploratory study was designed to: 1) describe the self-reported impact of CRC on older patients’ financial and psychosocial well-being; 2) identify unmet resource and service needs and assess awareness of cancer support organizations; and 3) determine whether the impact of CRC on financial and psycho-social well-being and on unmet needs varies by income.

Methods: We recruited English and Spanish-speaking patients age 65 or older who were receiving or recently completed adjuvant chemotherapy for stage II or III CRC at Memorial Sloan-Kettering Cancer Center (MSKCC) in New York City, an MSKCC regional site, or at one of three New York City minority-serving cancer centers. In semistructured interviews, patients were asked about worries related to cancer and treatment, changes in their financial situation and in paid and unpaid activities since diagnosis, and knowledge of resources available from cancer support organizations. Patients also reported their monthly pretax income, education, and other demographic characteristics.

Results: Eighty percent of eligible patients agreed to participate; 50 patients enrolled by May 2010. Participants’ mean age was 73; 82% had stage III CRC, 56% were male, 48% were married, 68% had more than a high school education, and 76% were white, non-Hispanic. Thirty-four percent reported monthly household income between $0 and $2,000,16% between $2,001 and $3,000,12% $3,001 and $4,000, and 36% $4,001 +. Patients with $2,000 or less in monthly income were more likely to report worries about having to ask friends for help, families having to rearrange their lives around them, and being a burden to their families. Patients with $2,000 or less in monthly income were also more likely to report that someone in their household had to change work hours to accommodate their illness and treatment, and that someone in their household had to work fewer hours or quite a job since the patient's cancer diagnosis. Patients with monthly incomes over $2,000 were more likely to report worries about being an emotional burden to a spouse or partner and that they reduced or gave up volunteer work or other regular activities as a result of their CRC. Awareness of support organizations was low (3 out of 10 possible) regardless of income.

Conclusions: CRC patients with lower incomes are more likely to report worrying about the need to rely on friends and family for financial and practical support; their families were more likely to experience disruption in work and income. Patients with higher incomes worried more about the emotional impact of their cancer on a spouse or partner. Interventions to increase awareness and use of local resources and services may reduce risk of psycho-social and financial hardship, especially in lower income patients.

Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):A51.