Purpose: Decision making for cancer patients can be difficult, as they face costly treatment with uncertain outcomes. Patients’ optimism, numeracy and perception of whether their family has already made sacrifices to pay for care may affect their choices. However, the relationships between these factors have not been well defined.
Methods: We are conducting a cross sectional study to understand how cancer patients make tradeoffs among treatments of varying cost, efficacy and toxicity. Patients >6 months from diagnosis are being recruited from academic and community hospitals. Patients were asked if their families had made sacrifices to pay for their care. Numeracy was assessed by the Subjective Numeracy Scale (divided into tertiles) and sense of optimism by the Revised Life Orientation Test (scores >17 were considered optimistic). To identify characteristics associated with patients perceiving their care to be a sacrifice, we used logistic regression models with sacrifices as the outcome of interest. Sociodemographics, numeracy and optimism were independent variables (Model 1). We built similar models with optimism as the outcome of interest. Sociodemographics and numeracy were independent variables (Model 2).
Results: 316 patients were enrolled. Median age was 60 years (range 27-90), female gender 61%, and white race 86%. 43% were college-educated with 38% reporting an annual income of >$72,000. 16% were receiving care at a community hospital. 55% were optimists. 21% report that their family made prior sacrifices. In Model 1, patients >65 (OR 0.32 p<0.01) and optimists (OR 0.55 p=0.039) are less likely to report sacrifices. In Model 2, patients with higher numeracy (OR 1.56 <0.01) and age > 65 (OR 1.62 p=0.043) weree likely to be optimists. In this exploratory analysis, there were no significant associations between income, education, gender, marital status, employment, hospital or presence of metastases and whether patients were optimistic or consider their care a sacrifice.
Conclusions: Patients’ perceptions of whether care represents a financial sacrifice to their family may be related more to optimism than sociodemographic characteristics such as income or education. Further research is needed to understand the relationship between numeracy and optimism as well as the temporal relationship between optimism and perception of sacrifices. These factors may be important for oncologists as they counsel patients and attempt to understand their motivations for accepting or declining treatments.
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