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Financial difficulties are associated with greater total pain and suffering among patients with advanced cancer: results from the COMPASS study

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Abstract

Background

The Universal Health Coverage goals call for access to affordable palliative care to reduce inequities in “total pain” and suffering. To achieve this, a patient-centred understanding of these inequities is required.

Aim

To assess association of total pain and suffering (i.e. physical, psychological, social, and spiritual health outcomes) and perceived health care quality with financial difficulties among stage IV solid malignancy patients.

Design

Using baseline data from the COMPASS cohort study, we assessed total pain and suffering including physical (physical and functional well-being, pain, symptom burden), psychological (anxiety, depression, emotional well-being), social (social well-being), and spiritual (spiritual well-being, hope) outcomes and perceived health care quality (physician communication, nursing care, and coordination/responsiveness). Financial difficulties were scored by assessing patient perception of the extent to which their resources were meeting expenses for their treatments, daily living, and other obligations. We used multivariable linear/logistic regression to test association between financial difficulties and each patient-reported outcome.

Setting/participants

Six hundred stage IV solid malignancy patients in Singapore.

Results

Thirty-five percent reported difficulty in meeting expenses. A higher financial difficulties score was associated with worse physical, psychological, social, spiritual outcomes, and lower perceived quality of health care coordination and responsiveness (i.e. greater total pain and suffering) (all p < 0.05). These associations persisted after adjustment for socio-economic indicators.

Conclusion

Results identify advanced cancer patients with financial difficulties to be a vulnerable group with greater reported total pain and suffering. A holistic patient-centred approach to care at end-of-life may help meet goals for Universal Health Coverage.

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Acknowledgements

We thank Ratna Singh for the excellent project management for this study and Jing Rong for the research assistance provided on this paper. COMPASS Study team: Dent RA, Kumarakulasinghe NB, Malhotra R, Cheung YB, Nadkarni N, Yee ACP, Yang GM, Chan N, Yeo WL.

Authorship

CM and RH conceptualized the study and led the writing for the manuscript. All authors participated in interpretation of data analysis, and revising and editing the manuscript for submission.

Funding

This work was supported by Singapore Millennium Foundation and Lien Centre for Palliative Care (LCPC-IN14-0003).

Author information

Authors and Affiliations

  1. Lien Centre for Palliative Care, Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore

    Chetna Malhotra, Irene Teo, Semra Ozdemir & Eric Finkelstein

  2. Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore

    Chetna Malhotra, Irene Teo, Semra Ozdemir & Eric Finkelstein

  3. Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, Cicely Saunders Institute, King’s College London, London, UK

    Richard Harding

  4. National Cancer Centre Singapore, Singapore, Singapore

    Irene Teo, Patricia Neo & Ravindran Kanesvaran

  5. Saw Swee Hock School of Public Health, Yong Loo Lin School of Medicine, Singapore, Singapore

    Gerald C. H. Koh

  6. Department of Haematology, Singapore General Hospital, Singapore, Singapore

    Lai Heng Lee

Authors
  1. Chetna Malhotra
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  2. Richard Harding
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  3. Irene Teo
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  4. Semra Ozdemir
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  5. Gerald C. H. Koh
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  6. Patricia Neo
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  7. Lai Heng Lee
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  8. Ravindran Kanesvaran
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  9. Eric Finkelstein
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Consortia

COMPASS Study team

  • R. A. Dent
  • , N. B. Kumarakulasinghe
  • , R. Malhotra
  • , Y. B. Cheung
  • , N. Nadkarni
  • , A. C. P. Yee
  • , G. M. Yang
  • , N. Chan
  •  & W. L. Yeo

Corresponding author

Correspondence to Chetna Malhotra.

Ethics declarations

Conflict of interest

The authors declare that there is no conflict of interest.

Ethics and consent

The study was approved by SingHealth Centralised Institutional Review Board (ref no: 2015/2781).

Additional information

What is already known about the topic?

•Goals for Universal Health Coverage aim to reduce inequities in total pain and suffering among patients at end of life.

•A holistic patient-centred approach to understanding these inequities is currently lacking.

What this paper adds?

•We comprehensively assessed inequities in total pain and suffering outcomes comprising of physical, psychological, social, and spiritual outcomes and perceived health care quality.

•We demonstrate that advanced cancer patients with financial difficulties are worse in all total pain and suffering outcomes.

Implications for practice, theory, or policy

•Direct assessment of financial difficulties among patients with advanced cancer should be done to identify patients at-risk of greater total pain and suffering.

•To achieve Universal Health Coverage goals, a patient-centred approach focusing on reducing inequities in all total pain and suffering outcomes is required.

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Malhotra, C., Harding, R., Teo, I. et al. Financial difficulties are associated with greater total pain and suffering among patients with advanced cancer: results from the COMPASS study. Support Care Cancer 28, 3781–3789 (2020). https://doi.org/10.1007/s00520-019-05208-y

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