Paying the highest price: Financial toxicity of gynecologic oncology patients undergoing treatment in the deep south (282)

Abstract

<b>Objectives:</b> Treatment of gynecologic cancers can lead to significant financial and productivity burdens, causing long-term detriments to patients even after their treatment is complete. This is particularly true in states without Medicaid expansion and with high rates of disease. We use a validated tool to understand financial toxicity in gynecologic oncology patients undergoing treatment in the Deep South, where rurality, poverty, and racial disparities disproportionately affect a much higher percentage of the population. <b>Methods:</b> Patients undergoing active treatment for gynecologic cancers were asked to complete a survey about cancer-related costs. The Comprehensive Score for Financial Toxicity (COST) tool was used with <26 indicating moderate and <14 indicating severe financial toxicity. The COST scores for groups based on demographic and clinical data obtained from the medical record were compared as well as the relationship of COST score was compared to reported opportunity costs. Statistical analyses were done using t-test, Fischer's Exact, and Wilcoxon rank-sign tests. <b>Results:</b> Forty-six patients were approached to complete the survey. Of these, 40 patients filled out the survey completely and had clinical data available. The mean age was 59 years (range: 28-89). Among the participants, 67% were White, and 33% were Black; 52.5% had an annual household income of less than $40,000. Twenty-seven patients (67.5%) had public insurance, and ten (25.0%) had private. Patients were being treated for ovarian (27.5%), uterine (30.0%), cervical (32.5%), or vulvar/vaginal cancers (12.5%). Patients were receiving chemotherapy (90%), radiation (35.0%) and/or immunotherapy (17.5%). Five patients (12.5%) were on a clinical trial. Twenty-eight patients (70%) experienced financial toxicity, with ten (25%) experiencing severe toxicity. Age, race, education level, and insurance status were not significantly different between patients who had financial toxicity versus those who did not, though there was a trend toward higher education level and private insurance with the absence of financial toxicity. Income was associated with moderate and severe financial toxicity (p=0.02). Financial toxicity did not differ for patients based on cancer type, treatment type, or the time spent on travel or in a clinic. The severity of the patients' perceived financial burden directly correlated with the COST score (p<0.01). Lower COST scores were associated with a higher likelihood of unemployment or disability due to treatment (p<0.01). Lower COST scores were also associated with a higher likelihood of having to borrow money (p<0.01), using their savings for medical expenses (p<0.01), and being unable to pay for basic necessities (p<0.01). In addition, family members of patients with lower COST scores were more likely to start working more (p<0.01) (Figure 1). <b>Conclusions:</b> Our patients in the Deep South experience financial toxicity at almost double the rate of previous reports. Financial toxicity has been associated with poor outcomes, bankruptcy, generational poverty, and widening disparities experienced by these patients. More research is needed on financial toxicity to improve cancer care equity, particularly as newer and more expensive agents become the standard of care.