Financial toxicity in patients with gynecologic malignancies

Abstract

<h3>Objectives:</h3> Financial toxicity is a growing burden in cancer survivors caused by the cost of treatment. This study aims to evaluate financial toxicity among gynecologic oncology patients and to assess patient related risk factors. <h3>Methods:</h3> This is a single institution cross sectional survey study that included two survey tools, as well as patient demographics and disease characteristics. Financial toxicity is measured by validated Comprehensive Score for Financial Toxicity (COST) tool, which uses responses to eleven items to generate a composite measure of financial burden ranging from 0 to 44, with lower scores indicating higher financial toxicity. Participants were also asked to complete a 55-question-survey on attitudes and perspectives surrounding cost of care. Descriptive statistics was used to report patient demographics. Correlation matrix was calculated to assess the relation between financial toxicity and patient/disease related variables. Graphpad Prism Software Version 8.0 was used for analyses. <h3>Results:</h3> A total of 50 patients with various gynecologic malignancies were enrolled. Overall, 48% had ovarian (24/50), 40% had endometrial (20/50), 8% had cervix (4/50), 2% had vulva (1/50) and 2% (1/50) had vaginal cancers. Mean age at cancer diagnosis was 60.6 years. Eighty percent (40/50) of the patients were receiving treatment at the time of enrollment, while 20% were under surveillance. Twenty two percent (9/41) were actively treated in a clinical trial at the time of survey completion, although overall enrollment was 40% (20/50) since diagnoses. Eighty percent (40/50) of the patients had private insurance, 4% (2/50) had Medicare, 10% (5/50) had Medicare with supplement, 4% (2/50) had Medicaid and 2% (1/50) had Medicaid with supplement. Overall median COST score was 20.5 (range 1 - 33). Correlation matrix analysis showed that COST score is correlated with age (r= -0.3, p=0.02) and malignancy type (r= -0.3, p=0.03). Ovarian cancer patients had significantly less financial toxicity (median COST score=23) when compared to patients with other gynecologic malignancies (median COST score=17, p=0.04). Ovarian cancer patients reported higher annual income when compared to non-ovarian (Table). When scores were dichotomized into low (score ≥ 22) and high toxicity (score < 22), 58% (29/50) of the patients were noted to have high financial toxicity. Enrollment to a clinical trial did not significantly alleviate financial burden. Patients, who were enrolled in clinical trials, had a median COST score of 23, while the median score was 18 in patients, who were not in clinical trials (p=0.2). <h3>Conclusions:</h3> Financial toxicity is a significant burden even among highly insured gynecologic oncology patients. Increased awareness of physicians and cost coping strategies are needed to optimize quality of care.