Sensitivity of Psychosocial Distress Screening to Identify Cancer Patients at Risk for Financial Hardship During Care Delivery
J Alberto Maldonado, Shuangshuang Fu, Ying-Shiuan Chen, Chiara Acquati, K Robin Yabroff, Matteo P Banegas, Shine Chang, Rena M Conti, Cristina M Checka, Susan K Peterson, Pragati Advani, Kimberly Ku, Reshma Jagsi, Sharon H Giordano, Robert J Volk, Ya-Chen T Shih, Grace L Smith, J Alberto Maldonado, Shuangshuang Fu, Ying-Shiuan Chen, Chiara Acquati, K Robin Yabroff, Matteo P Banegas, Shine Chang, Rena M Conti, Cristina M Checka, Susan K Peterson, Pragati Advani, Kimberly Ku, Reshma Jagsi, Sharon H Giordano, Robert J Volk, Ya-Chen T Shih, Grace L Smith
Abstract
Purpose: Patients with cancer frequently encounter financial hardship, yet systematic strategies to identify at-risk patients are not established in care delivery. We assessed sensitivity of distress-based screening to identify patients with cancer-related financial hardship and associated care delivery outcomes.
Methods: A survey of 225 patients at a large cancer center assessed cancer-related financial hardship (0-10 Likert scale; highest quintile scores ≥ 5 defined severe hardship). Responses were linked to electronic medical records identifying patients' distress screening scores 6 months presurvey (0-10 scale) and outcomes of missed cancer care visits and bad debt charges (unrecovered patient charges) within 6 months postsurvey. A positive screen for distress was defined as score ≥ 4. We analyzed screening test characteristics for identifying severe financial hardship within 6 months and associations between financial hardship and outcomes using logistic models.
Results: Although patients with positive distress screens were more likely to report financial hardship (odds ratio [OR], 1.21; 1.08-1.37; P < .001), a positive distress screen was only 48% sensitive and 70% specific for identifying severe financial hardship. Patients with worse financial hardship scores were more likely to miss oncology care visits within 6 months (for every additional point in financial hardship score from 0 to 10, OR, 1.28; 1.12-1.47; P < .001). Of patients with severe hardship, 72% missed oncology visits versus 35% without severe hardship (P = .006). Patients with worse hardship were more likely to incur any bad debt charges within 6 months (OR, 1.32; 1.13-1.54; P < .001).
Conclusion: Systematic financial hardship screening is needed to help mitigate adverse care delivery outcomes. Existing distress-based screening lacks sensitivity.
Conflict of interest statement
Ying-Shiuan ChenStock and Other Ownership Interests: Novavax, Inovio Pharmaceuticals, Trevena, Vaxart, Heat Biologics, Agenus Matthew P. BanegasEmployment: VIR BiotechnologyStock and Other Ownership Interests: VIR BiotechnologyResearch Funding: AstraZeneca Chang ShineLeadership: IBS CorpStock and Other Ownership Interests: Anthem Inc, Walgreens Reshma JagsiEmployment: University of MichiganStock and Other Ownership Interests: Equity QuotientConsulting or Advisory Role: Amgen, VizientResearch Funding: AbbVie, GenentechExpert Testimony: Baptist Health/Dressman Benziger Lavalle LawTravel, Accommodations, Expenses: AmgenOther Relationship: JAMA OncologyOpen Payments Link: https://openpaymentsdata.cms.gov/physician/373670/summary Robert J. VolkResearch Funding: AstraZeneca Ya-Chen T. ShihConsulting or Advisory Role: Pfizer, AstraZenecaResearch Funding: Novartis Grace L. SmithResearch Funding: Varian Medical SystemsOther Relationship: Oncora MedicalNo other potential conflicts of interest were reported.
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Source: PubMed