A recent study showed greater financial toxicity, worse health, and worse disease-free survival (DFS) in patients with head and neck cancer (HNC) with an annual income below the lowest income quintile. The study findings were reported in JAMA Otolaryngology-Head & Neck Surgery.

The prospective cohort study examined annual household income at the time of diagnosis and included patients with HNC who were seen at a tertiary care center in Toronto, Ontario, Canada, from September 17, 2015, to December 19, 2019. The primary outcome was DFS, and secondary outcomes involved financial toxicity and health utility. Associations between measures were also evaluated.

Financial toxicity was evaluated using the Financial Index of Toxicity (FIT) instrument, and health utility was evaluated with the Health Utilities Index Mark 3 (HUI3). Patients were grouped into quintiles by annual household income.

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The study evaluated 555 patients, mean age was 52.7 years (SD, 10.7). The researchers found that 2-year DFS was lowest, at 67% (95% CI, 58%-78%) in patients of the lowest income quintile, which reflected an annual income less than CAD$30,000. In comparison, the top quintile, with an income of CAD$90,000 or more, had a 2-year DFS of 88% (95% CI, 83%-93%).

In risk-adjusted models to evaluate survival, the lowest-income quintile showed an adjusted hazard ratio (aHR) for DFS of 2.13 (95% CI, 1.22-3.71), relative to the highest-income quintile, which was set to have a reference aHR of 1. For overall survival, the lowest-income quintile had an aHR of 2.01 (95% CI, 0.94-4.29), compared with the highest-income quintile (aHR, 1).

Regarding financial toxicity, patients in the lowest income quintile had a mean FIT score of 22.6, compared with 11.7 for those in the highest income quintile. Higher FIT scores represent greater financial toxicity. A multivariable analysis showed that FIT scores were a mean 134.6% (95% CI, 16.3%-252.9%) higher for the lowest income quintile than they were for the highest income quintile.

Using the HUI3, health utility scores for those in the lowest income quintile were a mean 0.104 points (95% CI, 0.026-0.182) lower for those in the highest income quintile. Lower HUI3 scores reflect worse health status.

“This work enriches our understanding of social inequalities for patients with HNC,” the researchers concluded in their report, noting that patients with HNC whose annual income was in the lowest income quintile — less than CAD$30,000, in this study — showed enhanced risks of worse oncologic outcomes, poor health, and financial toxicity.

Disclosures: Some authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.


Noel CW, Hueniken K, Forner D, et al. Association of household income at diagnosis with financial toxicity, health utility, and survival in patients with head and neck cancer. JAMA Otolaryngol Head Neck Surg. Published online November 23, 2022. doi:10.1001/jamaoto.2022.3755