Financial Worries Top Psychosocial Concern of Cancer Patients

Elsevier Global Medical News. 2011 Feb 28, B Bates
ANAHEIM, CALIF. (EGMN) -Highlighting shifting priorities after the recession, nearly half of all recent psychosocial consultations with patients at a leading cancer center involved financial worries, rather than adjustment issues or other pressing mental health concerns.
Among 313 single-episode encounters at the Cleveland Clinic’s Taussig Cancer Institute during one month in late summer 2010, 49% focused on financial issues, according to a study presented at the annual conference of the American Psychosocial Oncology Society.
These included a lack of adequate health insurance, inability to afford medications, housing crises, and/or difficulties in meeting basic financial obligations during cancer treatment, reported Christa Poole, a social worker at the institute.
“This study was a result of the [social work] team noticing a trend in increased consultation requests and interventions related to financial need,” Ms. Poole said in an interview.
Among patients’ presenting concerns were losses of benefits from layoffs, high COBRA premiums, and housing foreclosures, with these challenges often taking precedence over the more existential struggles faced by patients facing life-altering or life-threatening cancer diagnoses.
In the study, mental health distress – including coping challenges, adjustment to the diagnosis or treatment, and acute risk assessment for suicidality – constituted 37% of social work consultations, followed by other issues, including coordination of family meetings to discuss goals of care or decision making (5%), and domestic or family violence (2%).
The institute’s five social workers are now very often placed in a position of having to focus immediate attention on patients’ basic needs, while staying attuned to their depression, anxiety, grief, and changes in life roles and self-image, according to Ms. Poole.
“Cancer care, in most cases, cannot wait. These financial worries cause significant distress and when not addressed, may cause barriers to quality care,” she said.
At times, money woes are now directly impinging on medical care, she added, affecting choices patients and families make about cancer treatment regimens or symptom management. “Unfortunately, some patients choose care or treatment that will avoid debt or hardship for their loved ones,” even when those choices may affect their survival or comfort, said Ms. Poole.
“We don’t want to see patients in situations where they are choosing between paying an electric bill and paying for a drug to control nausea, when we know that patients need both.”
Financial burdens influence adherence as well, she noted: “When patients can’t afford gas or copays, they often cancel or ‘no-show’ for appointments.”
The “devastation of financial recession” has not only jolted the priorities of cancer patients, but also has taxed the institutional and external philanthropic assistance programs that once addressed such needs, said Ms. Poole.
“Resources are continuing to dwindle. Programs are simply running out of funding and are much less able to extend financial assistance,” she said. “This issue deserves continued attention and investigation, as the problem may worsen. How will hospital policies and programs respond to absorbing unpaid medical debt?”
Ms. Poole said her department continues to track trends in consultation, “as the full impact of the economic crisis continues to unfold in health care.”
Investigators reported no relevant financial disclosures.