Financial toxicity – the financial strain experienced by patients accessing health care – is often greater among cardiovascular disease patients compared to cancer patients, and those with both conditions suffer the highest burden, according to a study published June 15 in JACC: CardioOncology.

Javier Valero-Elizondo, MD, MPH, et al., used data from the National Health Interview Survey from 2013-2018, to look at 141,826 non-elderly (18 to < 65 years) adults, of which 6,887, 6,093 and 971 had cancer, atherosclerotic cardiovascular disease (ASCVD) or both, respectively. The study used a self-reported diagnosis of coronary disease, cerebrovascular disease and/or cancer, and utilized the Sample Adult Core information with relevant information from the Household and Family Core components, which researchers supplemented with demographic and socioeconomic characteristics, health status, health care services and health-related behaviors in the U.S. adult population.

Results showed that most individuals with cancer and/or ASCVD in the study population were 40-64 years old, insured and white. Female participants were more likely to report having cancer, with a majority coming from middle-/high-income households and with a higher education level. Those reporting ASCVD, with or without cancer, were evenly distributed by sex, education and income levels but had a more unfavorable cardiovascular risk profile. The most reported cancers included non-melanoma skin, breast, cervix, prostate and "other," which was also seen among those reporting both ASCVD and cancer.

Any financial toxicity was more likely to be present in patients with both ASCVD and cancer, those with ASCVD, those with cancer and those with neither cancer nor ASCVD. Difficulty paying bills was significantly higher for ASCVD patients with and without cancer compared to patients with only cancer. Overall, the same pattern (ASCVD and cancer > ASCVD > cancer > neither) was observed for high financial distress, cost-related medication non-adherence, food insecurity and delayed/foregone medical care due to cost, when compare those reporting ASCVD with or without cancer versus cancer. Patients with both cancer and ASCVD had increased odds of experiencing any financial toxicity measured in the study. In a sub-analysis of elderly patients, the same pattern was observed for all financial toxicity measures at significantly lower rates.

"There is an urgent need for effective methods to alleviate financial toxicity for heart disease and cancer patients. In the current health system, there are already small- and large-scale strategies to identify and combat financial toxicity. This has already been observed among oncologists when prompted to talk to their patients about financial burden in the office," said Khurram Nasir, MD, MPH, MSc, FACC, senior author of the paper. "It is especially important for clinicians who care for patients with heart disease and/or cancer, given the high economic burden facing these patients."

In a related editorial comment, Reza Arsanjani, MD, and Nandita Khera, MD, MPH, explain that moving forward, "More rigorous research, policy level initiatives, and better integration with clinical workflow can ensure that catastrophic financial consequences for patients do not undermine the scientific progress by making ability to pay a limiting criterion for treatment."

Clinical Topics: Cardio-Oncology, Vascular Medicine

Keywords: Cardiotoxicity, Prostate, Cervix Uteri, Cerebrovascular Disorders, Coronary Disease, Medication Adherence, Breast Neoplasms

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