title: Determinants of Patient-Centered Financial Stress in Patients With Locally Advanced Head and Neck Cancer.
abstract: To prospectively estimate patient-centered financial stress and its relationship with health care utilization in patients with head and neck cancer. This was a survey-based, longitudinal, prospective study of treatment-naïve patients with stage III, IVa, or IVb locally advanced head and neck cancer at a single-institution tertiary care hospital from May 2013 to November 2014. With 121 patients approached, 73 (60%) agreed to participate.
  
  
  
  Self-reported data were collected on demographics, income, wealth, cost-coping strategies, out-of-pocket costs, supportive medication compliance, and perceived social isolation. Health care utilization was measured by hospital admissions and outpatient appointments on a 6-month timeline. Logistic regression models were constructed to identify factors associated with use of cost-coping strategies. Covariates included all demographics, measures of income, wealth, out-of-pocket costs, indirect costs, and perceived social isolation.
  
  
  
  Fifty-one patients (69%) relied on at least one coping strategy. On multivariable analysis, Medicaid patients were more likely than privately insured patients to use cost-coping strategies (odds ratio, 42.3; P = .0042). Decreased wealth ( P = .002) and higher total out-of-pocket costs ( P = .003) were independently associated with using cost-coping strategies. Patients with high perceived social isolation were also more likely to use cost-coping strategies (odds ratio, 11.5; P = .01). Patients with high perceived social isolation were more likely to report nonadherence to supportive medications (21.4 v 5.45 days over 6 months; P = .0278) and missed appointments (seven v three; P = .0077).
  
  
  
  A majority of patients used at least one cost-coping strategy during their treatment, highlighting the financial stress that patients experience. Perceived social isolation is an important social determinant of increased medication nonadherence, missed appointments, and use of cost-coping strategies. Interventions should be investigated in at-risk patients who may suffer from financial stress.
authors.affiliation: The University of Chicago, Chicago, IL.
authors.forename: Jonas A
authors.initials: JA
authors.lastname: de Souza
authors.affiliation: The University of Chicago, Chicago, IL.
authors.forename: Sunny
authors.initials: S
authors.lastname: Kung
authors.affiliation: The University of Chicago, Chicago, IL.
authors.forename: Jeremy
authors.initials: J
authors.lastname: O'Connor
authors.affiliation: The University of Chicago, Chicago, IL.
authors.forename: Bonnie J
authors.initials: BJ
authors.lastname: Yap
mesh_terms: D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D005260:Female; D006258:Head and Neck Neoplasms / Q000453:epidemiology / Q000473:pathology* / Q000523:psychology*; D005102:Health Expenditures; D006801:Humans; D007902:Length of Stay; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D057566:Self Report; D013315:Stress, Psychological; D011795:Surveys and Questionnaires; D013997:Time Factors