Cost-coping strategies that alter lifestyle are used by most patients with locally advanced head and neck cancers (LAHNC). This research was presented at the 2016 Multidisciplinary Head and Neck Cancer Symposium. In addition, perceived social isolation, or lack of social support coupled with increased loneliness, was identified as a risk factor for suboptimal medication adherence and health care utilization during treatment for LAHNC.1
This prospective longitudinal study collected 6 monthly lifestyle surveys from 73 patients with treatment-naïve LAHNC diagnosed at a single, high volume institution between May 2013 and November 2014. The survey assessed the use of several lifestyle-altering financial coping strategies, as well as out-of-pocket costs, loss of productivity, adherence to their medication regimen, and health care utilization (specifically, inpatient length of hospital stays and number of missed appointments). Researchers also measured patients’ demographics, health insurance status, wealth, household income, and type of tumor. Perceived social isolation was evaluated prior to treatment for each patient.
Most patients in the study was male (78%), Caucasian (74%), and had private health insurance (54.8%).
One or more lifestyle-altering cost-coping strategy was relied upon by more than two-thirds of the patients in the study (69%). The most common strategy was spending savings (62%), followed by borrowing money (42%), selling possessions (25%), and having family members work more hours (23%).
Patients with Medicaid used more financial coping strategies compared with patients with private insurance (Odds Ratio [OR], 42.3; P = .005). In addition, increased out-of-pocket costs and decreased wealth were independently associated with the use of cost-coping strategies (P < .01).
“Physical side effects are not the only ones our patients endure,” said lead author Sunny Kung, a second-year medical student at the University of Chicago Pritzker School of Medicine in Illinois. ”Our findings indicate that the majority of our patients have adopted or will adopt strategies to cope with the financial side effects of their care.”
Perceived social isolation was identified in 7 of the 73 patients (9.5%) prior to treatment. Patients who reported high perceived social isolation were more likely to be unemployed (P = .02) and divorced or widowed (P < .001).
High perceived social isolation prior to treatment predicted lower health care utilization in the following 6 months. Compared with patients with LAHNC who have adequate social support, those in the perceived social isolation cohort reported more days missing prescribed medication (21.4 vs. 5.45 days over 6 months, P = .02), more missed appointments (7 vs. 3 appointments, P = .007), and longer inpatient hospital stays (32.7 vs. 27.6 days over 6 months, P = .17).
“Many of the patients we treat for advanced head and neck cancers may need support beyond their medical care,” said Kung. “Social interventions can be introduced for patients who feel isolated in order to minimize financial burden while maximizing effective health care utilization. For example, providers can work with patient navigators to improve adherence to medical care among vulnerable populations.”
1. Kung S, O’Connor J, Yap BJ, et al. Cost-coping strategies and perceived social isolation in locally advanced head and neck cancer. Presented at: 2016 Multidisciplinary Head and Neck Cancer Symposium; Scottsdale, AZ; February 18-20, 2016. Abstract 323.