SCOTTSDALE, Ariz.-Locally advanced head and neck cancer (LAHNC) has high morbidity and is expensive to treat. The cost of the disease, not only in financial burden but also degradation of the patient's quality of life, was highlighted in a recent study from University of Chicago Pritzker School of Medicine.
The study, using data from 73 treatment-naive LAHNC patients, showed that 69 percent relied on one or more lifestyle-altering cost-coping strategies while managing their cancer, including spending savings (62 percent), borrowing money (42 percent), selling possessions (25 percent), and having family members work more hours (23 percent).
A more subtle disruption of patients' lives was also identified, that of perceived social isolation- defined as a lack of social support coupled with increased loneliness-as a risk factor for less than optimal medication adherence and use of health care resources during treatment. That meant more days of missed medication, more missed appointments, and longer inpatient hospital stays.
The study was presented at the 2016 Multidisciplinary Head & Neck Cancer Symposium, sponsored by the American Society for Radiation Oncology and the American Society of Clinical Oncology.
"Physical side effects are not the only ones our head and neck cancer patients endure," said Sunny Kung, a second-year medical student and lead author on the study. "It is important for physicians to screen for social isolation just as we screen for depression and identify patients with high social isolation so we can intervene earlier on before they experience these negative financial side effects of their care."
Senior study author is Jonas de Souza, MD, Assistant Professor of Medicine at The University of Chicago Medicine and frequent author on healthcare economics as well as head and neck malignancies.
Research Findings
The researchers examined factors associated with social side effects by following patients diagnosed with head and neck cancer over six months to assess how they coped with the cost of their cancer treatment, as well as whether perceived social isolation or the lack of social support was a barrier to their care.
"It was surprising that patients who had a high degree of perceived social isolation had a greater likelihood of using more lifestyle coping strategies," Kung said, during an online press conference held in advance of the symposium.
The prospective longitudinal study collected six monthly lifestyle surveys from patients diagnosed between May 2013 and November 2014.
Most patients in the study were male (78 percent), Caucasian (74 percent), and covered by private health insurance (54.8 percent). Multivariable regression modeling was used to assess the influence of patient characteristics on the use of cost-coping strategies and perceived social isolation.
The survey assessed the use of lifestyle-altering financial burdens including extra out-of-pocket costs, loss of productivity, low compliance with their medication regimen, and added health care utilization, specifically, longer inpatient length of hospital stays and more missed appointments.
The researchers also measured patients' demographics, health insurance status, wealth, household income, and type of tumor. Perceived social isolation was evaluated prior to treatment for each patient.
During the online preview of the symposium, Kung elaborated on the concept of social isolation as measured in two components: loneliness and lack of social support.
The first was measured using the validated UCLA Loneliness Scale, and the second by the 19-item Medical Outcomes Social Support Survey. The two scores were combined in a formula to determine low, intermediate, or high social isolation.
Kung said that, compared to LAHNC patients with adequate social support, those with a high level of perceived social isolation reported:
* more days missing the prescribed dose of medication, 21.4 days for those with high perceived social isolation versus 5.45 days for those with low/moderate perceived social isolation;
* more missed appointments, seven for those with high perceived social isolation versus three for those with low/moderate perceived social isolation; and
* longer inpatient hospital stays, 32.7 versus 27.6 days.
"Many of the patients we treat for advanced head and neck cancers need support beyond their medical care," Kung concluded. "Social interventions can be introduced for patients who feel isolated in order to minimize financial burden while maximizing effective health care utilization."
For example, she said, providers can work with patient navigators to improve adherence to medical care among vulnerable populations.
Need for Support
The moderator of the press preview, Randall Kimple, MD, Assistant Professor in the Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, said this study's findings would have to be replicated in other institutions.
"Even so, these are important lessons for us to learn about what our patients go through, and potential areas of research into how to lessen social isolation and all the other hardships while still doing everything we can cure as many patients as possible," Kimple said.
This study's findings on social isolation may apply to other cancers, he said, but he noted that head and neck cancer is unique in the intensity of therapy and the side effects that come with therapy and that affect quality of life.
"Losing the ability speak, to eat, to work, and the social isolation that can result, these can be devastating, but we as physicians can help to address many of these issues with teaching and support, and have a real impact on the lives of our patients," Kimple said.