Patient Reported Outcomes and Financial Toxicity in Head and Neck Cancer (PaRTNer): Longitudinal Assessment of Financial Toxicity and an Educational Intervention from a Pilot Study

Abstract

<h3>Purpose/Objective(s)</h3> Patients undergoing definitive head and neck cancer (HNC) treatment are at risk for high out-of-pocket (OOP) costs given complex treatment and high symptom burden. The PaRTNer pilot study was designed to assess costs, financial toxicity, and the benefit of education for patients undergoing definitive radiation (RT) for HNC. <h3>Materials/Methods</h3> Eligibility: adult patients with newly diagnosed non-metastatic HNC undergoing RT for definitive cancer treatment. Baseline survey collected demographics, cancer details, OOP costs, and COmprehensive Score for financial Toxicity (COST) score to measure financial toxicity. Patients received a binder with educational materials regarding financial toxicity and logs to document OOP costs. Repeat surveys at 3 and 6 months (mo) evaluated OOP costs, financial toxicity, and benefits of the provided binder. COST scores over time were evaluated by mixed-effects model (restricted maximum likelihood) and Dunnett's multiple comparisons test in scientific 2-D graphing and statistics software. <h3>Results</h3> 60 patients were enrolled from 2019-2021 with 58 (baseline), 52 (3 mo), and 48 (6 mo) completing surveys longitudinally. Most were white (76%), non-Hispanic (98%), and male (67%), with median age of 61 (range 42-86). Oropharynx was the most common primary disease site (48%), and 48% received concurrent chemotherapy with RT. 59% were working part-time or full-time, and 55% had employer-sponsored private insurance. Annual household income was >$60,000 for 55% of patients. Mean COST scores at baseline, 3 mo, and 6 mo post-RT were 21.3, 19.2, and 18.6, respectively (adjusted p=0.002, baseline vs 6 mo), with lower COST score indicating worse financial toxicity. Cumulative median OOP cost was $3460 (Range: $16-20614). At baseline, 64% had little or no understanding about the costs of their cancer care, and 69% felt that educational materials about costs would be helpful. 56% and 71% of patients at 3 and 6 mo post-RT felt that the binder of educational materials provided at study enrollment was very helpful. At 3 mo post-RT, 96% indicated this information should be given to all cancer patients. <h3>Conclusion</h3> Patients undergoing definitive RT for HNC experienced borderline financial toxicity prior to RT and a small but significant increase in financial toxicity at 6 mo post-RT. Most patients had limited baseline understanding about cancer costs and found study educational materials increasingly helpful over time. This pilot study demonstrates feasibility of longitudinal assessment of financial toxicity for HNC patients undergoing RT and highlights the potential utility of educational interventions, warranting assessment in future prospective studies. This was a single-institution, prospective longitudinal study (NCT3506451).