Neurosurgery patients with brain tumors show preoperative financial capacity deficits compared to healthy controls
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Key Takeaway
Consider systematic assessment of financial capacity in neuro-oncology evaluations given preoperative deficits and variable postoperative trajectories.
This prospective observational study included 21 patients with brain tumors and 21 age- and education-matched healthy controls at a neuro-oncology center. The primary exposure was neurosurgery involving tumor resection, with comparisons made against healthy controls and pre-surgery baseline measurements. The primary outcome assessed was financial capacity (FC), while secondary outcomes included functional independence and awareness of financial skills by patients and caregivers.
Before neurosurgery, Total NADL-F scores were significantly lower in patients compared to controls. FC-related deficits were most pronounced in reading abilities and item purchase tasks. Following surgery, 33% of patients showed improvement in FC, whereas 24% of patients showed further decline. Additionally, FC was associated with lesion size and the presence of cognitive deficits as measured by MoCA and FAB scores.
Patients consistently overestimated their FC, and caregivers also overestimated patients' financial skills. No specific adverse events, serious adverse events, discontinuations, or tolerability data were reported in the study. Key limitations include the small sample size and the observational nature of the design, which precludes causal inferences regarding the impact of neurosurgery on FC. The practice relevance underscores the importance of including a systematic assessment of FC in the neuro-oncological evaluation process.
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IntroductionFinancial capacity (FC) is a functional ability, mediated by cognitive functions, that is vulnerable to neurological conditions; its decline negatively affects independence in daily life. This study aimed to explore FC impairments and their evolution in patients with neoplastic brain lesions, taking into account: the influence of lesion and socio-demographic characteristics and cognitive functioning on FC; the relationship between impaired FC and functional independence, also considering patients’ awareness of their own financial skills and that of their caregivers.MethodsA prospective observational design was adopted; 21 patients with brain tumors and 21 age- and education-matched healthy controls were enrolled at a neuro-oncology center. FC was evaluated using the standardized Numerical Activities of Daily Living—Financial (NADL-F) test. Cognitive functioning was screened with the Montreal Cognitive Assessment (MoCA) and the Frontal Assessment Battery (FAB); functional independence was assessed with the Instrumental Activities of Daily Living (IADL) scale.ResultsBefore neurosurgery, patients exhibited significantly lower total NADL-F scores compared to controls. The most pronounced FC-related deficits were observed in reading abilities and item purchase tasks. After tumor resection, 33% of patients showed improvement in FC, whereas 24% patients showed a further decline of their performance in financial tasks. FC was associated with lesion size and the presence of cognitive deficits (MoCA and FAB scores). Patients consistently overestimated their FC, as did their caregivers.ConclusionFinancial capacity appears to be substantially compromised in patients with brain tumors, with the degree of impairment correlating with tumor volume and cognitive deficits and worsened by a lack of awareness of the difficulties in the financial domains. The post-surgical outcomes are variable, with complete and partial recovery or further deterioration of FC. These results underscore the importance of including a systematic assessment of FC in the neuro-oncological evaluation process.
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