Standard Financial Hardship Screen Identified At-Risk Groups

By Leah Lawrence - Last Updated: November 1, 2022

Using a financial hardship (FH) screen, researchers identified key groups that were more likely to report hardship in a relatively affluent population at a large cancer center. FH was also associated with worse survival.

The researchers established a standardized approach to describe the prevalence and predictors of FH as part of routine clinical workflow. FH was measured with the question, “how hard is it for you to pay for the very basics like food, housing, medical care, and heating?”. Respondents had five response options: not hard at all, not very hard, somewhat hard, hard, and very hard. Responses were coded to identify those with any FH, regardless of severity.

“To our knowledge, our study is one of the first to examine how to systematize the universal assessment of FH as part of the routine cancer care delivery,” the researchers wrote. “Automating the screening process can help overcome barriers, such as time and staffing constraints, and avoid the stigma that some patients associate with these questions. At the same time, it can provide valuable information that can affect patient care.”

In this study, 31,154 patients were screened from FH from 2018 to 2020. FH was reported by 14%.

There was a significantly higher likelihood of having FH among racial/ethnic minority patients, those who were unemployed/disabled, single, or divorced, patients from disadvantaged neighborhoods, and those who were self-pay or had government insurance.

The researchers also looked at possible associations between FH and survival. They found that patients who had FH has a 46% increased risk of mortality (hazard ratio=1.46; 95% CI, 1.31-1.63; P<.001) compared with those who did not report FH.

“We need studies to validate this finding with added disease information and to elucidate the biologic mechanisms and social pathways for risk of increased mortality with FH,” the researchers wrote. “Using health information technology to improve integration of screening and management of FH, while optimally using currently available resources to ensure delivery of high-quality affordable care, can address the unmet need around FH in patients with cancer as part of routine clinical care.”



Assessing Patient-Reported Financial Hardship in Patients With Cancer in Routine Clinical Care