JCO oncology practice · 2026
Associations Between Cancer-Related Financial Hardship, Pain, and Opioid Use.
СтатьяНазвание и аннотация: Перевод в очереди
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Williams Courtney P, Olisakwe Sandra, El Dick Joud, Deng Luqin, Azuero Andres, Pisu Maria, Eaton Ellen, Rocque Gabrielle B
Аннотация
PURPOSE: Cancer-related financial hardship, encompassing the high out-of-pocket treatment costs and associated distress, is associated with adverse treatment outcomes. However, its impact on clinical outcomes such as pain remains underexplored.
METHODS: This secondary, retrospective cohort study examined associations between financial hardship and pain among patients with cancer initiating systemic therapy. Patient-reported pain was captured weekly over the first 6 months of treatment via remote symptom monitoring. Financial hardship was assessed at treatment initiation via the FACIT-COST instrument. Opioid use was abstracted from electronic medical records. Generalized linear models estimated associations between pain and financial hardship using relative risks (RR), predicted probabilities, and corresponding 95% CIs. Associations between financial hardship and opioid use were similarly modeled, stratified by pain severity.
RESULTS: Of 331 patients (median age 60 years; 28% Black; 40% stage IV), 48% reported financial hardship. Moderate/severe pain was reported by 25% and 24% at 3 and 6 months after treatment initiation, respectively. In adjusted models, patients reporting financial hardship had a 37% higher risk of moderate/severe pain over 6 months compared with those reporting no/minimal financial hardship (RR, 1.37 [95% CI, 1.04 to 1.80]). During cancer treatment, patients reporting financial hardship had higher probabilities of opioid use than those reporting no/minimal financial hardship, both among those with moderate/severe (55% [95% CI, 40 to 77] v 44% [95% CI, 30 to 63]) and no/mild pain (40 [95% CI, 30 to 53] v 30% [95% CI, 21 to 42]).
CONCLUSION: Financial hardship is associated with increased risk of pain and greater opioid use during cancer treatment. Integrating financial screening into clinical workflows may identify high-risk patients and inform interventions, such as financial navigation and tailored pain management, to mitigate the clinical consequences of financial hardship.
METHODS: This secondary, retrospective cohort study examined associations between financial hardship and pain among patients with cancer initiating systemic therapy. Patient-reported pain was captured weekly over the first 6 months of treatment via remote symptom monitoring. Financial hardship was assessed at treatment initiation via the FACIT-COST instrument. Opioid use was abstracted from electronic medical records. Generalized linear models estimated associations between pain and financial hardship using relative risks (RR), predicted probabilities, and corresponding 95% CIs. Associations between financial hardship and opioid use were similarly modeled, stratified by pain severity.
RESULTS: Of 331 patients (median age 60 years; 28% Black; 40% stage IV), 48% reported financial hardship. Moderate/severe pain was reported by 25% and 24% at 3 and 6 months after treatment initiation, respectively. In adjusted models, patients reporting financial hardship had a 37% higher risk of moderate/severe pain over 6 months compared with those reporting no/minimal financial hardship (RR, 1.37 [95% CI, 1.04 to 1.80]). During cancer treatment, patients reporting financial hardship had higher probabilities of opioid use than those reporting no/minimal financial hardship, both among those with moderate/severe (55% [95% CI, 40 to 77] v 44% [95% CI, 30 to 63]) and no/mild pain (40 [95% CI, 30 to 53] v 30% [95% CI, 21 to 42]).
CONCLUSION: Financial hardship is associated with increased risk of pain and greater opioid use during cancer treatment. Integrating financial screening into clinical workflows may identify high-risk patients and inform interventions, such as financial navigation and tailored pain management, to mitigate the clinical consequences of financial hardship.