333 Financial Toxicity in Malignant Brain Tumors

Abstract

INTRODUCTION: As costs for cancer care continue to rise, ongoing development of novel therapeutics have increased the number of patients living with cancer. Cancer survivors are at increased risk of having high medical debt burdens, bankruptcy, delayed treatments, poor compliance with therapy, and even death as a result of financial toxicity. METHODS: Hospital billing database was queried for patients with ICD code C71 who had a bad debt discharge (unpaid balance) on record from 2020-2022. The corresponding hospital chart was then queried for demographic data, patient factors, and clinical factors. RESULTS: 43 total patients had data available for analysis. The patient diagnoses were GBM (50%), Other (45.2%), followed by metastatic disease (4.7%). White patients had an average bad debt of $2742.10, while Black patients averaged $9851.6 (p = 0.017). 38.5% of White patients had more than $2000 in bad debt, compared to 81.8% of Black patients in that category (p = 0.014). The amount of debt differed significantly between tumor types; with 66.7% of GBM patients having more than $2000 in bad debt (p = 0.052). Difference in debt amount based on pre-operative employment status trended towards significance but fell short (p = 0.08). Most patients were unemployed (58.9%), followed by employed patients (33%), and retired patients (7.6%). 61.5% of employed patients had greater than $2000 in bad debt, compared with 56.5% of unemployed patients. 40% of patients had a pre-operative deficit, and of those patients, 54% had a bad debt amount in excess of $2000. 71% of patients without a pre-operative deficit had more than $2000 in bad debt. CONCLUSIONS: Bad debt is a major contributor to financial toxicity in patients with malignant brain tumors.