Patient-Reported Distress And Medical Expenses In Patients Receiving Definitive Radiation Therapy

Out of pocket medical expenses are increasingly a concern to patients receiving radiation therapy (RT). The presence of concurrent cancer diagnoses and mental health issues are associated with increased care costs. In 2012, our RT clinic began to prospectively assess patient reported distress (PRD). The primary aim of this study was to retrospectively evaluate the association between overall PRD and medical expenses during definitive RT. Between April 2012 and May 2015, 948 patients completed a PRD questionnaire within 90 days of the start of RT, of which 678 were treated with definitive intent. The PRD form consisted of 30 categorical questions (scale 1 to 5) highlighting possible causes of distress and the NCCN longitudinal analog distress thermometer (scale1 to 10) as a measure of overall PRD. Patients were retrospectively assigned into 2 groups, CancerOnly (CaO) and CancerPlus (CaP). CaP was composed of patients who scored 4 or higher on the overall distress thermometer, plus patients who scored 3 or higher on any of the following categorical questions (irritability, sleep, panic, nervous/anxious, fear of procedures, anger, feeling depressed, anhedonia, poor concentration). Remaining patients were categorized under the CaO group. Demographic data, cancer related information, billing diagnoses, and treatment cost were compared between groups. Acute cost was defined as all costs incurred at our institution within 6 months post primary cancer diagnosis and follow-up cost as all cost incurred during 6 to 24-months post cancer diagnosis. Monthly average cost using the number of months with billed services was used to adjust for potential lost to follow-up and censoring. CaP group contained 495 (73.0%) patients, while CaO group had 183 (27.0%) patients. The monthly average cost per patient in CaP group was 32.4% higher than those patients in CaO group. A total of 118 (17.4%) patients expired, 75 (11.06%) and 43 (6.34%) in CaP and CaO respectively. Of the patients who received RT with a curative intent, those who died had 2.3 times higher average medical expenses than those patients who survived. The percentage difference of the monthly average cost between deceased CaP and deceased CaO patients remained high at 28.33%, with CaP having the higher cost. Out of pocket medical expenses rated third as a primary concern to patients from the 30 categorical PRD questions. Distressed patients receiving definitive RT had significantly higher medical expenses compared to less distressed patients. The end of life was associated with increased care costs with the CaP group’s cost higher than the CaO group at this time. Further research is warranted to better define the association between PRD and cost of care during definitive RT.