Comparing financial hardship (FH) assessment tools among gynecologic cancer patients (491)

Abstract

<b>Objectives:</b> Up to 50% of gynecologic oncology patients experience financial hardship (FH). Several FH screening tools are available; however, it is unclear which tool is optimal. We aimed to compare four FH screening tools. <b>Methods:</b> We conducted a pilot study implementing universal FH screening in an academic gynecologic oncology practice among patients starting a new line of therapy. The four screening tools included: the 11-item COmprehensive Score for financial Toxicity (COST) tool, the National Comprehensive Cancer Network Distress Thermometer, a 10-item financial needs (FN) checklist of difficulty affording care-related needs (utilities, transportation/lodging for treatments, upfront payments, insurance, medications, medical supplies, child/elder care, employment, basic needs), and a single-item question ("Do you have difficulty affording medications?"). <b>Results:</b> Of 137 patients starting a new therapy from February to August 2021, 131 (96%) underwent screening. The average age was 60.4 years (range: 19-84), and 30.6% were non-White. Cancer types included ovarian (40.0%), uterine (36.6%), cervical (17.6%), and vulvar/vaginal/other (7.6%). Most patients had a primary disease (55.7%) and were on first-line (55.0%) systemic therapy. Twenty-six (19.8%) patients had a COST score <26 indicating FH, and 42 (30.7%) had a distress score ≥4 indicating moderate/higher distress. On the FN checklist, 37 (28.2%) patients had difficulty affording > 1 item, including affording insurance/medical bills (payments due after the service) (<i>n</i>=18), upfront payments (due at the time of service) (<i>n</i>=12), and utilities (<i>n</i>=11). More patients with COST<26 had difficulty affording > 1 FN checklist item compared to those with COST >26 (73.1% vs 14.4%), whereas patients with distress > 4 and distress <4 had a similar frequency of difficulty affording > 1 FN checklist item (31.0% vs 25.8%). All patients responded no to the single-item question, "Do you have difficulty affording medications?" although four patients reported difficulty affording medications on the FN checklist. Thirteen (9.9%) patients reported specific practical/financial concerns on the distress thermometer; 46.2% (<i>n</i>=6) of these patients had a COST <26, and 76.9% (<i>n</i>=10) had > 1 FN checklist item. <b>Conclusions:</b> Universal screening for FH is feasible in patients starting treatment. A specific FH multi-item screening tool may be needed; however, a single item about affording medications may not be useful.