title: A composite measure of personal financial burden among patients with stage III colorectal cancer.
abstract: 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.
  
  
  METHODS
  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.
  
  
  METHODS
  We used factor analysis to compute a composite measure of financial burden. We used χ tests to evaluate relationships between individual components of financial burden and chemotherapy use with χ analyses. We used Mantel-Haenszel χ 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.
authors.affiliation: *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.
authors.forename: Christine M
authors.initials: CM
authors.lastname: Veenstra
authors.forename: Scott E
authors.initials: SE
authors.lastname: Regenbogen
authors.forename: Sarah T
authors.initials: ST
authors.lastname: Hawley
authors.forename: Jennifer J
authors.initials: JJ
authors.lastname: Griggs
authors.forename: Mousumi
authors.initials: M
authors.lastname: Banerjee
authors.forename: Ikuko
authors.initials: I
authors.lastname: Kato
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Ward
authors.forename: Arden M
authors.initials: AM
authors.lastname: Morris
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000191:economics; D015179:Colorectal Neoplasms / Q000188:drug therapy / Q000191:economics* / Q000473:pathology; D017281:Cost of Illness; D003625:Data Collection; D016527:Drug Costs / Q000706:statistics & numerical data; D005163:Factor Analysis, Statistical; D005260:Female; D005382:Financing, Personal / Q000191:economics* / Q000706:statistics & numerical data; D005845:Georgia / Q000453:epidemiology; D006801:Humans; D008297:Male; D008824:Michigan / Q000453:epidemiology; D008875:Middle Aged; D009367:Neoplasm Staging / Q000191:economics; D012959:Socioeconomic Factors
chemical_list: D000970:Antineoplastic Agents