Understanding financial toxicity in head and neck cancer survivors

Leila J. Mady, Lingyun Lyu, Maryanna S. Owoc, Shyamal D. Peddada, Teresa H. Thomas, Lindsay M. Sabik, Jonas T. Johnson, Marci L. Nilsen

Research output: Contribution to journalArticlepeer-review


Objectives: (1) Describe financial toxicity (FT) in head and neck cancer (HNC) survivors and assess its association with personal/health characteristics and health-related quality of life (HRQOL); (2) examine financial coping mechanisms (savings/loans); (3) assess relationship between COmprehensive Score for financial Toxicity (COST) and Financial Distress Questionnaire (FDQ). Patients and methods: Cross-sectional survey from January – April 2018 of insured patients at a tertiary multidisciplinary HNC survivorship clinic who completed primary treatment for squamous cell carcinoma of the oral cavity, oropharynx, or larynx/hypopharynx. Results: Of 104 survivors, 30 (40.5%) demonstrated high FT. Patients with worse FT were more likely (1) not married (COST, 25.33 ± 1.87 vs. 30.61 ± 1.34, p = 0.008); (2) of lower education levels (COST, 26.12 ± 1.47 vs. 34.14 ± 1.47, p < 0.001); and (3) with larynx/hypopharynx primaries (COST, 22.86 ± 2.28 vs. 30.27 ± 1.50 vs. 32.72 ± 1.98, p = 0.005). Younger age (4.23, 95%CI 2.20 to 6.26, p < 0.001), lower earnings at diagnosis (1.17, 95%CI 0.76 to 1.58, p < 0.001), and loss in earnings (-1.80, 95%CI −2.43 to −1.16, p < 0.001) were associated with worse FT. COST was associated with HRQOL (0.08, p = 0.03). Most survivors (63/102, 60%) reported using savings and/or loans. Worse FT was associated with increased likelihood of using more mechanisms (COST, OR1.06, 95%CI 1.02 to 1.10, p = 0.004). Similar results were found with FDQ. Conclusions: We found differences in FT by primary site, with worst FT in larynx/hypopharynx patients. This finding illuminates potential site-specific factors, e.g. workplace discrimination or inability to return to work, that may contribute to increased risk. FDQ correlates strongly with COST, encouraging further exploration as a clinically-meaningful screening tool.

Original languageEnglish (US)
Pages (from-to)187-193
Number of pages7
JournalOral Oncology
StatePublished - Aug 2019
Externally publishedYes


  • Cost sharing
  • Head and neck cancer
  • Health expenditures
  • Health services
  • Health-related quality of life
  • Multidisciplinary research
  • Out-of-pocket expenses
  • Patient reported outcomes
  • Survivorship
  • Treatment costs

ASJC Scopus subject areas

  • Oral Surgery
  • Oncology
  • Cancer Research


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