Preferred cost communicator in BRCA mutation carriers (483)

Abstract

<b>Objectives:</b> Prior research has established Financial Toxicity (FT), the cumulative financial burden experienced by patients due to medical care, as a significant adverse outcome of medical treatment. As a result, professional medical societies have encouraged physicians to discuss FT with their patients, but data on patient preference surrounding these conversations are limited. Assessment of FT in <i>BRCA</i> mutation carriers has been largely unstudied. This analysis represents nascent research on FT in this high-risk patient population and examines preferences of <i>BRCA</i> mutation carriers related to their costs of care, including preferred cost communicator (the person with whom they would most prefer to discuss the costs of their medical treatment). <b>Methods:</b> This abstract represents a subanalysis of our novel, crosssectional study of FT in patients with <i>BRCA1/2</i> mutations. <i>BRCA+</i> patients were recruited via phone and/or email; patients who agreed to participate completed consents and surveys on RedCap. The COST tool, a validated measure, was used for the assessment of FT. COST scores were divided into tertiles, with high FT defined as COST score < 24. Cost communication preferences, demographics, and medical history were also assessed. <b>Results:</b> A total of 76 <i>BRCA</i> positive female patients who met enrollment criteria had responded at the time of this analysis. Most patients (58.9%) responded that they would like to know the out- of-pocket (OOP) costs of their treatment before receiving it. When surveyed regarding preferred cost communicator, most patients (32.8%) preferred to speak with a financial counselor, with 27.6% preferring a physician. When dividing patients into high FT <i>(n</i> = 23) and low/medium FT groups (<i>n</i> = 39), no differences were seen in desire to know OOP costs beforehand (60.9% vs 59%, <i>p</i> = 0.61). Preferred cost-communicator did not differ statistically amongst high and low/medium FT groups (<i>p</i> = 0.16). However, a trend was seen where patients with high FT were more likely to want to speak with a physician about the cost of care (31.8% vs 30.8%). In contrast, patients with low FT were more likely than their high FT counterparts to want to speak to a financial counselor (35.9% vs 27.3%) or social worker (20.5% vs 9.1%) about their costs of care. <b>Conclusions:</b> This is the first study of <i>BRCA+</i> patients' cost communication preferences. As previously reported, financial toxicity exists in this high-risk patient population, and there is a strong patient desire to better understand their own OOP costs. Patients' preferences for discussing care with financial counselors, regardless of their FT severity, indicate that multidisciplinary teams may be beneficial for addressing questions about the costs of care. Additional research with larger patient populations is needed to better understand preferred cost communicator trends seen amongst FT groups, with low/ mid FT groups seeming to prefer discussion about costs with nonpractitioners and high FT patients preferring physician counseling.