Background: Advanced cancer patients(AdCa) experience physical, psychological, existential/spiritual distress and financial distress(FD) associated with the disease or treatment. Regular assessments of these issues in the outpatient-setting are limited.  
 
Methods: We reviewed 289 consults of AdCa evaluated by our Supportive Care Outpatient-Center between October-2012 and January-2013. We used Edmonton Symptom Assessment Scale adding two items following the same scale(0 to 10) to evaluate: Spiritual Pain and FD, (ESAS-FS). We determined the frequency, intensity and correlates of self-reported FD (Distress/Suffering experienced secondary to financial issues) among these AdCa.
 
Results: Mean age(range): 60.1 years(22-92). 53% were male. 189(65%) were White, 45(15%) African American, and 34(12%) were Hispanic. Type of cancer: head and neck 62(21%), gastrointestinal 57(20%), breast 40(14%), lung 32(11%), urological 32(11%), and others 45(16%). 
187/289(65%) AdCa had FD: mean(95% Confidence-Interval) 4(3.5-4.4). AdCa with FD had worse Pain [mean(95%CI) 5.12(4.7, 5.6) vs. 4.3(3.6, 4.9)](p=0.028), depression [3.8(3.3, 4.2) vs. 1.5(1.1, 2.1), p<0.0001], anxiety [4.1(3.6, 4.6 vs. 1.6(1.1, 2.1), p<0.0001], Well-Being [5.2 (4.9, 5.6) vs. 4.3 (3.7, 4.9), p=0.006], and Spiritual Pain[2.4(2.0, 2.9) vs. 0.5(0, 1.0), p<0.0001]. FD correlated (Spearman) with Pain r=0.25, p<0.0001; Sleep r=0.29, p<0.0001; Depression r=0.41, p<0.0001; Anxiety r=0.45, p<0.0001; Drowsiness r=0.26, p<0.0001, Well-being r=0.25, p<0.0001; and Spiritual Pain r=0.44, p<0.0001. Logistic regression multivariate analysis showed association with Spiritual Pain[OR (95% Wald CI) 1.575(1.284-1.932), p<0.0001] and Anxiety [1.261 (1.083-1.488), p<0.0001].

Conclusion: FD was reported in more than 65% of AdCa. It correlates with physical and psychological, and spiritual distress. The use of ESAS-FS allows identifying AdCa with FD evaluated in a Supportive Care Outpatient Clinic. More research is needed.

05 / FINANCIAL DISTRESS AMONG ADVANCED CANCER PATIENTS ASSESSED IN A SUPPORTIVE CARE OUTPATIENT CENTER.