Out-of-pocket costs burden for cancer treatment toxicities and symptoms management in Italy: A prospective, multicenter pilot study.

Abstract

12105 Background: Financial Toxicity (FT) refers to the financial burden and stress experienced by cancer patients as a result of the high costs associated with their treatment and care. This burden can significantly impact patients and families, affecting not only their financial well-being but also their physical and mental health. With the increasing cost of cancer care, FT has become a primary concern for those affected by the disease. Although there have been plenty of studies on the cost of cancer drugs and policy issues relating to curbing these increasing costs, studies on addressing FT in individual patients for drug-related toxicity and symptom management are still lacking. Methods: From January to October 2022, we conducted a cross-sectional, descriptive study to identify patient-administered drugs used to manage cancer treatment toxicities or cancer-associated symptoms. We recognize six common symptoms (anorexia/cachexia, fatigue, nausea and vomiting, pain, constipation, and diarrhea). All social and demographic data, including information on gender, age, performance status, education, and income, have been gathered and recorded. We collected information about the type of cancer disease and active treatment (on/off). Symptom assessment and financial distress were analyzed by administering the PERSONS and COST questionnaires, respectively, at the time of enrollment. Results: A total of 211 patients were enrolled and completed the questionnaires. 28/211 patients (13%) do not take any medications to control symptoms. Of the remaining 183 taking at least one prescription for managing these symptoms, 90% (165) pay for at least part of these drugs. Most frequently, patients assumed medicines for controlling pain (45%) and constipation (28%). Unlike all the other drug categories, these medicines correlate with financial distress (p > 0.0001 and p > 0.001). None of the following variables (age, type of tumor, and work situation) significantly interacted with COST and PERSONS at the univariate analyses. In contrast, a lower level of education significantly associates with the worst COST and PERSONS scores (p > 0.0001). As expected, patients in palliative home care have a higher mean score for symptom burden than those without home care and, surprisingly, a higher financial distress score. Conclusions: Our results identify cancer pain and constipation as the most incident and challenging problems associated with cancer diagnosis and treatment. Moreover, they ultimately lead to a higher financial hardship due to patient self-prescribing and out-of-pocket purchases of over-the-counter drugs to control them. In our population, a lower education level is an independent risk factor for developing financial distress.