Protective and Exacerbating Factors for Financial Hardship in Head and Neck Cancer

Introduction: Financial hardship presents a devastating challenge for patients with cancer. However, financial hardship in head and neck cancer (HNC) is not well understood nor routinely assessed. This study explored the experiences regarding financial burden in HNC and identified potential gaps from the existing financial hardship screening tool “COmprehensive Score for financial Toxicity” (COST).

Methods: This multi-institutional, prospective, qualitative study recruited 24 patients between two hospital sites: a tertiary-care academic center and county safety-net hospital. Qualitative interviews were conducted among patients who completed HNC treatment. Thematic analysis was performed to develop themes relating to financial burden in HNC. Themes were evaluated to identify missing gaps in COST.

Results: Twenty-four patients (median 66 years [range, 29-77], 83% male, 29% non-English speakers) were interviewed. Tumor sites included oral cavity, larynx/hypopharynx, oropharynx, nasopharynx, sinonasal, cutaneous, thyroid, and parotid. Social support, stable baseline financial status, and insurance coverage helped protect against financial hardship. Conversely, unstable baseline financial status, difficulty accessing resources, inability to return to work, high out-of-pocket costs, and transportation barriers intensified financial burden. Although COST captured some elements of financial burden, key domains pertinent to HNC were missed, such as unknown out-of-pocket costs that emerged only after treatment, transportation burdens, caregiver sacrifices, and mismatched expectations about timing and feasibility of return to employment.

Conclusions: Themes of financial challenges relating to HNC treatment emerged, revealing gaps not captured by the existing COST tool. These findings may inform methods to more accurately identify and measure financial hardship unique to the HNC patient population.