Financial Toxicity in the Spanish Speaking Population
Authors: Quiroz Elisa , Godinez Alberto 
Published: December 2023

Advances in therapy have significantly improved cancer survival outcomes but with a harmful patient consequence: financial toxicity. Financial toxicity consists of a patient's many economic burdens from cancer treatment, encompassing direct healthcare costs as well as additional devastating financial consequences, such as job loss and medical bankruptcy. With rising cancer treatment costs, financial toxicity has become a problem that is increasingly impactful in both cancer treatment and survivorship, amplifying disparities, negatively impacting quality of life, treatment adherence and survival.

The long-term research goal that this study will contribute to is to develop culturally appropriate and effective patient navigation resources and psychosocial support resources for interventions to increase coping and resilience to financial toxicity in high-risk populations. This study will seek to generate the early data needed to help develop the content and method of delivering strategies, tailored for an underserved, Spanish-speaking Latino population.

Eligibility

Participant must be 18 years of age or older at the time of study participation, able to read and speak Spanish, have diagnosis of cancer within the past 2 years or be on active treatment for their cancer; all disease sites and all stages are eligible for enrollment. We will exclude patients unable to give consent.

Methods

This is a prospective observational study of cancer patients and survivors, with participants to be recruited from Scripps MD Anderson Cancer Center. Participating clinics will be screened in the electronic medical record for individuals who meet above eligibility criteria. At the time of clinic visits, eligible individuals will be approached.

Individuals who express that they would like to participate in the survey study will receive the study packet with the consent statement and baseline survey questions. Study participants will also be invited to participate in the OPTIONAL patient navigation portion of the study.

Participants who are not active on the MyScripps patient portal will be invited to join the patient navigation portion of the study. Those elect to participate will be provided a device if they do not have their own. Participants will be given a Greenphire Clincard on which they will receive a total of $75 in three installments. Research team members will enter the item responses into the REDCap database.

They will undergo a follow-up survey during a range from 4 months to 9 months from the initial survey date. Those participating in the patient navigation portion of the study will be contacted by the navigator on a monthly basis through the electronic portal or telephone.

Statistics

We plan to enroll N= 80 Spanish-speaking patients in the survey study. For correlation testing, we hypothesize a moderate effect size (correlation = 0.32) for the association between the primary outcome measure, the baseline measure of self-efficacy (Hope State score) and the baseline financial toxicity score (Economic Strain and Resilience in Cancer). For feasibility testing of navigation participation, feasibility will be assessed through descriptive statistics. We hypothesize that it is feasible for 50% of invited patients to participate. When the sample size is 40, a two-sided 95% confidence interval for participant completion rate will extend 0.15 from the observed proportion for an expected proportion of 0.50.

Analysis

The primary outcome measure is financial toxicity, measured using the ENRICh instrument at baseline. The primary predictor is the baseline Hope State score. This modeled association is of primary interest in the analysis. We will conduct descriptive and univariate/multivariate analyses on this association of primary interest, including Chi-square test, t-test. Other univariate and multivariate analyses of associations between financial toxicity and other measures obtained from survey measures, as well as clinical, demographic, socioeconomic, and care delivery variables, considered descriptive and exploratory, will be performed. Accounting for multiple comparisons will be based on stepdown procedures and familywise error rate control; we plan to control this overall error rate using the Holm-Sidak adjustment, or procedure with equitable properties.