Self-reported financial difficulties of colorectal cancer patients 1 year after start of treatment.

BACKGROUND

The purpose of this study is to investigate self-reported financial difficulties (FDs) in patients with colorectal cancer (CRC) and to develop easy-to-implement models to predict FDs 1 year after initiation of CRC treatment.

MATERIALS AND

METHODS

In the prospective EDIUM cohort, CRC patients are asked to complete the European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Core 30 (QLQ-C30) and QLQ-CR29 before (T0) and 1 year after initiation of treatment (T1). These patient-reported outcomes are combined with sociodemographic and clinical data. The QLQ-C30 'FD' item is firstly analysed descriptively, together with covariates. Logistic lasso regression was carried out to develop a predictive model (full model) of FDs at T1, and its predictive capacity was assessed. This predictive model was then simplified using easy-to-collect predictors which showed importance in the full model.

RESULTS

Of 9124 CRC patients enrolled between October 2018 and May 2023, 6061 completed follow-up questionnaires (T1). Of those initially without FDs (n = 4989), 25% (1248 patients) reported new FDs at T1. These patients were younger [median age 66 versus 72 years; odds ratio (OR) 2.81 (95% confidence interval [CI] 2.46-3.22)] and had a higher proportion of lower educational attainment [74% versus 69%; OR 1.32 (95% CI 1.14-1.54)]. Clinically, FDs were more frequently reported by patients with higher International Union Against Cancer (UICC) stages [48% in stages III/IV versus 32.5% in stages I/II; OR 1.98 (95% CI 1.74-2.26)] and rectal cancer [37% versus 28%; OR 1.52 (95% CI 1.32-1.73)]. The full model [based on a test and training dataset of n = 5910 patients, including 14 predictors, area under the curve (AUC) 0.75] was reduced to two simplified models with only the predictors age, sex (model 1, AUC 0.72)/localisation of tumour (model 2), and FDs at T0 (AUC = 0.74). On this basis, two risk assessment tables were developed.

CONCLUSIONS

A significant proportion of CRC patients report FDs 1 year after treatment initiation, particularly among socioeconomically disadvantaged groups. Together with the predictive models and two ready-to-use risk assessment tables, these findings can be utilised by clinicians and psychosocial counselling services to provide tailored support options.