Financial Toxicity In Patients Research Articles

Financial toxicity in patients with glioblastoma.

There has been mounting interest in understanding the impact of financial toxicity (FT) in various cancer types; however, it remains poorly understood and understudied within neuro-oncology-especially as it relates to neurosurgical components of patient care. Retrospective, single-center study of patients who underwent craniotomy for resection of glioblastoma from 2020 to 2022. OIBEE™ (Austin, Texas) software was queried to identify the subset of these patients who had a bad debt charged to their account. These patients were deemed to qualify as experiencing FT. Chi Square analysis was conducted between FT and non-FT patient groups. Additionally, survival analyses were performed to determine predictors of progression free and overall survival. 74 patients were included in this sample. 33/74 (44%) met criteria for FT. The average bad debt amount was $7,476.76 and the median debt amount was $2,015.96, with the average time to financial toxicity after surgery being approximately 127 days. FT patients were significantly younger at diagnosis than those who were not FT (64.6 years- non-FT vs. 59.0 years- FT, p = 0.0344). FT patients were more likely to have undergone subtotal resections rather than a gross total resection compared to non-FT patients (FT GTR 27.3%, non-FT GTR 52.4%, p = 0.028). Hospital length of stay was significantly longer for FT patients compared to non-FT patients (LOS FT 9.5 days, non-FT 6.5 days, p = 0.0312). Glioblastoma patients are at high risk of experiencing FT with our series showing no significant impact on overall survival. Larger studies are needed to understand the impact of FT on patient outcomes.

Correlation of a single-item measure of financial toxicity with overall score.

351 Background: Financial toxicity (FT) refers to the financial burden experienced by patients due to direct and indirect costs associated with their medical care. It has been linked to higher symptom burden, poorer clinical outcomes, quality of life, and psychological well-being and has been shown to extend beyond diagnosis and treatment. Despite the availability of validated tools to measure FT, no single-item screening measure has been validated yet. In the context where time constraints are the most cited reason for patients declining FT surveys, it is crucial to develop efficient tools that allow us to routinely screen patients for FT at different stages of their care. We, therefore, sought to establish item 12 (“My illness has been a financial hardship to my family and me”) of the Comprehensive Score for Financial Toxicity (COST) measure as a well-functioning screening item for FT. Methods: In this secondary analysis of 579 patients who completed a survey on financial toxicity screening preferences, items 1-11 were scored (including reversing 7 items per the version 2 scoring guidelines), with lower scores indicating worse FT. Analyses focused on establishing a correlation with the total score as well as examining item properties. Item 12 was also reverse scored, so lower scores mean greater hardship. Results: Item 12 had an item-total correlation of r = 0.63 (adjusted item-total correlation = .531). Similarly, a linear model with item 12 score as a predictor and total score as the outcome showed that increases of 1 point on item 12 is associated with around 3 total points on the full scale (b = 3.35, p < .001, adjusted R 2 = 0.28. Finally, item analysis with the graded-response item response theory (IRT) model showed very good discrimination (a = 2.10) for item 12, indicating that it can reliably distinguish between low and high FT in patients. IRT results also showed that the item functions as a nearly binary item with responses of “quite a bit” and “very much” corresponding to a high probability of high FT, while responses of “somewhat,” “a little bit,” and “not at all” corresponding to a high probability of low FT. Conclusions: This is the first validation of a single-item screening measure for RT. Overall, these results illustrate that item 12 is a good candidate for a single-item screener, with “quite a bit” and “very much” responses indicating a high likelihood of high FT.

Relationship of Surgical Approach With Financial Toxicity in Patients With Resected Lung Cancer.

Minimally invasive surgery (MIS) reduces lengths of stay, complications, and potentially perioperative hospital costs. However, the impact of MIS on financial toxicity (FT), defined as the costs resulting from oncologic care and their negative effects on quality of life, in patients with lung cancer is unknown. Our objective was to investigate the association between surgical approach and FT in this population. A single-institution study was performed evaluating resected lung cancer patients (2016-2021). FT was assessed using the Comprehensive Score for Financial Toxicity (COST) questionnaire. The relationship between surgical approach (MIS vs. thoracotomy) and FT was evaluated using propensity score-matched (PSM) regression analysis. A sensitivity analysis involving the entire cohort was also performed using an inverse probability-weighted generalized linear model. As reported previously, of 1477 patients surveyed, 463 responded (31.3%) with FT reported in 196 patients (42.3%). Resection was performed by thoracotomy in 53.3% (n = 247), and by MIS in the remainder (n = 216, 46.7%; video-assisted thoracoscopic surgery [VATS] = 115; robotic-assisted = 101). There was no difference in FT in patients who underwent VATS and robotic-assisted surgery (p = 0.515). In the PSM analysis, MIS was not associated with FT (odds ratio [OR]: 0.980, 95% confidence interval [CI]: 0.628-1.533, p = 0.929). Similar results were found on sensitivity analysis (OR: 1.488, CI: 0.931-2.378, p = 0.096). Compared to MIS, thoracotomy was not associated with FT in patients with resected lung cancer. Though there are several benefits from MIS, it does not appear to be a meaningful strategy to alleviate FT in this population.

Hysterectomy and medical financial hardship among U.S. women

ObjectiveHysterectomy is one of the common surgical procedures for women in the United States. Studies show that hysterectomy is associated with elevated risk of developing chronic conditions, whichmay cause financial toxicity in patients. This study aimed to assess whether women who underwent hysterectomy had a higher risk of experiencing medical financial hardship compared to women who didn’t. MethodsUsing data on 32,823 adult women from the 2019 and 2021 waves of the National Health Interview Survey, we estimated binomial and multinomial logistic regressions to assess the relationship between hysterectomy and financial hardship, defined as problems paying or unable to pay any medical bills. Further, we performed a Karlson-Holm-Breen (KHB) decomposition to examine whether the association could be explained by chronic comorbidity. ResultsWhile the prevalence of financial hardship was 13.6 % among all women, it was 16.2 % among women who underwent a hysterectomy. The adjusted odds of experiencing medical financial hardship among women with a hysterectomy were 1.36 (95 % CI: 1.22–1.52) times that of their counterparts who did not have a hysterectomy. The KHB decomposition suggested that 34.5 % of the size of the effect was attributable to chronic conditions. Women who had a hysterectomy were also 1.45 (95 % CI: 1.26–1.67) times more likely to have unpaid medical debts. ConclusionsOur results suggested that women, who underwent a hysterectomy in the US, were vulnerable to medical financial hardship. Policy makers and health professionals should be made aware of this issue to help women coping against this adversity.

Financial toxicity in patients with cancer: a cross-sectional study at an oncology hospital in central Vietnam.

Cancer imposes a substantial financial burden on patients because of the high out-of-pocket expenses and the significant hardships. Financial toxicity describes the impact of cancer care costs at the patient level. Although the financial impact of cancer has been recognized, understanding the extent and determinants of financial toxicity in specific contexts is crucial. This study investigated the level of financial toxicity and its associated factors among patients with cancer at an oncology hospital in central Vietnam. This cross-sectional study included 334 patients with cancer. Direct interviews and medical record reviews were used for data collection. Financial toxicity was assessed using the 11-item Comprehensive Score for financial Toxicity (COST). A logistic regression model was used to determine factors associated with financial toxicity. A notable 87.7% of patients experienced financial toxicity due to cancer cost, with 37.7% experiencing mild financial toxicity and 49.7% suffering from moderate financial toxicity, 0.3% reporting severe financial toxicity. Individuals with low household income exhibited a higher proportion of financial toxicity compared to that of those with higher income (odds ratio (OR) = 5.78, 95% confidence interval (CI): 1.29-25.68). Compared with that of participants in the early stages, a higher burden was found in patients with advanced-stage cancer (OR = 3.88, 95% CI: 1.36-11.11). Our study indicates that patients with cancer in Vietnam facefinancial toxicity. It is thus necessary for interventions to mitigate the financial burden on patients with cancer, focusing on vulnerable individuals and patients in the advanced stages.

Influence of age on financial toxicity in cancer patients

ObjectiveThe aim of this study was to assess the level of financial toxicity (FT) experienced by the following three age groups of cancer patients in China: young working-aged patients (age < 40 years), middle-aged patients (40–64 years), and older patients (≥ 65 years). MethodsThe data used for this study were collected via a cross-sectional survey conducted in China. FT was assessed using the Comprehensive Score for Financial Toxicity (COST). ANOVA was used to examine the differences in FT status between age groups. Multivariate linear regression models were employed to assess the association between age and FT, adjusted by socioeconomic and other clinical characteristics. ResultsA total of 556 cancer patients completed the survey. Approximately 54.3% of the participants were male and 45.7% were female. The majority (61.5%) were aged 40–64 years, while 27.7% were aged 65 or older. The mean FT scores for young patients (< 40 years), middle-aged patients (40–64 years), and older patients (≥ 65 years) were 16.7, 12.8, and 12.4, respectively. The results of the regression analysis revealed that, without adjusting for background characteristics, young patients had significantly higher mean COST scores. This suggests they experienced lower levels of FT compared to patients in other age groups. Stratified analysis revealed that, for older patients, only educational level and type of insurance scheme were significant factors in predicting the COST score. ConclusionsThis study provides empirical evidence for developing targeted interventions and policies to reduce the FT for patients in different age groups. Given that FT is complicated, a longitudinal study should be conducted to explore the long-term impact of FT on cancer patients' quality of life and well-being.

The Risk of Financial Toxicity in Patients With Head &amp; Neck Cancer

The Risk of Financial Toxicity in Patients With Head &amp; Neck Cancer

Financial Toxicity in Patients With Chronic Pancreatitis.

Patients with chronic illnesses are susceptible to the financial burden of disease-related treatment costs. Financial toxicity is well researched in cancer and several chronic diseases. This review explores the financial challenges faced by patients with chronic pancreatitis and the impact of financial hardship on their well-being. We performed a review of the published literature to summarize the body of existing research and to identify knowledge gaps related to the financial burden experienced by patients with chronic pancreatitis. Research on financial burden, cost-coping behaviors, cost-related nonadherence to prescribed medications, and social vulnerabilities in people with chronic pancreatitis is sparse. No studies have assessed the suitability and validity of instruments measuring subjective financial toxicity in a patient population with chronic pancreatitis. There is a critical need for further studies of financial toxicity in the patient population with chronic pancreatitis, considering that if the sources of financial burden can be identified, opportunities emerge to dampen or mitigate their impact on patients with chronic pancreatitis.

Identifying objective risk factors of financial toxicity in patients with cancer.

e24116 Background: Current financial toxicity (FT) screening tools rely on patient-reported risk factors (RF)1. Underrepresented populations may not be forthcoming about FT fears due to cultural concerns of treatment withholding or migratory repercussions, if applicable1–4. Identifying objective RF, such as social determinants of health (SDH) and disease-specific factors (DSF), could reduce FT in cancer patients and healthcare systems. Methods: This was a multi-center retrospective study evaluating SDH and DSF associated with FT (defined as ≥$15,000 owed) related to cancer treatment. Inferential statistics were used to evaluate differences between the FT cohort and those who owed &lt; $15,000. Continuous data were compared with a Student’s t or Mann-Whitney U test, depending on distribution. Categorical outcomes were compared with a chi square test. A logistic regression model was used to evaluate multivariate associations with FT, using p &lt; 0.05 to define significant results. Results: The sample comprised 162 records, 81 in each group. Univariate analyses demonstrated differences in age, lack of PCP, non-US country of origin, lack of insurance, lower education levels, need for an English interpreter, stage 4 at diagnosis, recurrent or metastatic disease, use of immune checkpoint inhibitors (ICI), and use of targeted molecular therapy (TMT) (Table 1). Employment status and marital status were not statistically different. The logistic regression model showed that lack of insurance and stage 4 at diagnosis were significantly associated with FT (p = 0.001 and p = 0.0495, resp.). Conclusions: Objective FT screening can minimize response bias and incidence in those at increased risk. Non-US country of origin and lack of English proficiency suggests that first-generation Hispanics may not be appropriately navigated for FT. These findings identify specific subpopulations at risk for FT and will guide prospective interventions looking to minimize FT. Healthcare systems should analyze objective measures of FT while considering loco-regional and subcultural SDH/DSF in order to overcome response bias. Ref. Witte J et al. Methods for measuring financial toxicity after cancer diagnosis and treatment. Annals of Oncology. 2019;30(7) Strasser-Weippl K et al. Progress and remaining challenges for cancer control in Latin America and the Caribbean. Lancet Oncol. 2015;16(14) Zhu Z et al. Cancer survivors’ experiences with financial toxicity. Psychooncology. 2020;29(6) Chebli P et al. Multilevel determinants of financial toxicity in breast cancer care. Supportive Care in Cancer. 2020;28(7). [Table: see text]

Impact of race and ethnicity on financial toxicity in patients with genitourinary cancers.

11077 Background: Genitourinary (GU) cancers contribute substantially to the cost of healthcare in the United States (US). While advancements in cancer treatment have improved patient outcomes, disparities in healthcare costs persist, exacerbating the financial burden on vulnerable populations. We sought to investigate the disparities in costs of inpatient hospitalizations among patients with GU cancers in the US. Methods: Eligible adult GU cases from the Medical Expenditure Panel Survey (2019–2021) were included in this study. ICD-10 CM codes were utilized to identify renal cell, prostate, urothelial, testicular, and penile cancers. In addition to the total hospital inpatient (IP) facility expenditure, questions about ability to pay for healthcare were included in the analysis after accounting for the complex survey design and sampling weights. Results: The study included a weighted sample size of 9,061,181 (wt SE = 538,502) GU cases in the US between 2019 and 2021. The mean (95% CI) age of the sample was 71.6 (70.7, 72.5) years. The sample consisted of 7.9% Hispanics, 74.8% non-Hispanic White (NHW), 13.8% non-Hispanic Black (NHB), and 3.5% Asian or other races (NHA). In 2021, NHB participants reported the lowest annual family income of $51742 (18932, 106185), followed by Hispanics with $65233 (24314, 95859), and NHW with 82035 (36298, 158863). A greater proportion of the elderly NHW population was insured compared to NHB and Hispanics (44.9% vs. 32.5% vs. 19.5%), respectively. Of note, NHB patients had worse self-perceived physical and mental health compared to NHW and Hispanics, with 18.1% reporting fair or poor physical and mental health (vs. 8.1% and 14.3%, respectively). NHB participants reported higher rates of familial financial hardship (2019: 10.2% vs. 3.6%; 2020: 6.2% vs. 3.5%; 2021: 7.1% vs. 3.3%) or not being able to afford medical care (2019: 7.2% vs. 2.1%; 2020: 2.5% vs. 0.6%; 2021: 1.9% vs. 1.7%) when compared to NHW. Overall, mean total hospital IP facility expenses were: Hispanics = $2873.30 (1434.49, 4312.12); NHW = $4213.81 (3241.05, 5186.56); and NHB = $5199.99 (2842.93, 7557.05). After accounting for sample weights, gender, family income, age, insurance status, and survey year, Poisson regression analysis showed significant differences between different racial groups. Hispanics were less likely (𝛽=-0.48; p&lt;0.0001), while NHB (𝛽=0.152; p&lt;0.0001) and NHA (𝛽=0.48; p&lt;0.0001) were more likely to spend for an IP hospitalization when compared to NHW (ref.). Conclusions: Our data revealed racial disparities in the costs of inpatient hospitalizations, highlighting potential financial toxicity among patients with GU cancers. Additional investigation is warranted to elucidate factors contributing to these inequities, aiming to optimize cancer management and alleviate financial burdens. Addressing these disparities is crucial to prioritize equitable healthcare access and promote systemic change.

Financial toxicity in patients with metastatic breast cancer on trastuzumab deruxtecan (T-DXd).

1112 Background: T-DXd is a targeted therapy shown to improve outcomes in patients with metastatic breast cancer (MBC) who progressed on prior HER2 targeted therapies, or in the “HER2-low” population as presented at ASCO 2022. It is given every 3 weeks and costs about $9,500 per cycle. Little is known about treatment courses for patients on T-DXd and the potential financial toxicity (FT) of treatment including unmet essential needs. Methods: Retrospective review identified all patients with MBC treated with T-DXd from 6/2022 to 8/2023 at a comprehensive cancer center. Cross-sectional patient surveys assessed FT (via validated COST tool), ability to meet essential needs, payment concerns, and quality of life (QOL). Logistic regression assessed factors associated with unmet needs. A cohort of patients with MBC who did NOT receive T-DXd but completed a FT survey during the study period were identified for comparison. Results: 429 patients with MBC received T-DXd during the study period with a median of 7 cycles (IQR 3-12), and median length on treatment of 4 months (IQR 1.5-8). 164 (38% of the full cohort) completed a FT assessment after receiving at least one T-DXd cycle. Mean age at assessment was 56.9 years (SD 10.9); 72% identified as non-Hispanic White (NHW). Mean FT score was 19.2 (SD 10.8) (scale 0-44, lower scores indicate worse FT). 68% had COST &lt;26 diagnostic of FT. Mean QOL score was 6.3 [(SD 2.0) 0 “as bad as it can be” - 10 “as good as it can be]. QOL was correlated with FT score (r=0.48, p&lt;0.001). 21% of those who complete FT assessment had used at least some of their savings to pay for cancer treatment (5% had used all); 5% did not have savings to begin with. 23% took on new loans or borrowed money. Unmet essential needs were identified for: housing (15%), transportation (15%), food (11%), and repairs to home (10%). 11% reported they did not have enough monthly income for medications. On adjusted analysis including age, race/ethnicity, and FT status, those aged 46-65 years (OR 3.94, 95% CI 1.34-11.53, p=0.012), non-NHW (OR 4.54, 95% CI 1.86-11.08, p=0.001), and those with FT (OR 11.52, 95% CI 3.90-34.07, p&lt;0.001) were more likely to have an unmet essential need. Of those who screened positive for FT, 50% accepted referral for financial assistance. 440 patients with MBC completed a FT assessment but did NOT receive T-DXd. There was no difference in FT (COST: 19.9 vs. 19.2, p=0.492) or unmet needs (36% vs. 37%, p=0.850). Conclusions: After ASCO 2022, hundreds of patients with MBC received T-DXd at a large cancer center; however, most did not stay on treatment for long. Patients with MBC had significant FT, although this is not unique to treatment with T-DXd. This underscores the need to study and intervene upon FT across all MBC populations given negative influence on QOL and unmet essential needs identified. Additionally, improving the referral process is essential, as only half of those with identified needs accepted referral for assistance.

Objective financial toxicity in patients with cancer: a cross-sectional study

Objective financial toxicity in patients with cancer: a cross-sectional study

Addressing financial toxicity in cancer treatment-An opportunity for the 340B drug pricing program.

Cancer treatment has become increasingly expensive, partially due to the use of specialty drugs. The costs of these drugs are often passed down to patients, who may face the consequences of paying for more than they can afford, leading to financial toxicity. The 340B drug pricing program is a health care policy that may provide an opportunity to mitigate the financial consequences of cancer care. The 340B program requires manufacturers to sell outpatient drugs at a discount to hospitals caring for a significant number of socioeconomically disadvantaged individuals. The program intended for hospitals to use savings from discounted purchases to expand their safety net to vulnerable patients. Some studies have shown that participating hospitals do this by offering more charity and discounted care, whereas others have demonstrated that hospitals fail to sufficiently expand their safety net. A potential flaw of the program is the lack of guidance from governing bodies on how hospitals should use savings from discounted purchases. There has been growing discussion among stakeholders to reform the 340B program given the mixed findings of its effectiveness. With the rising costs of specialty drugs and associated prevalence of financial toxicity in patients with cancer, there is an opportunity to address these issues through reform that improves the program. Directing hospitals to offer specific safety net opportunities, such as passing along discounted drug prices to vulnerable populations, could help the growing number of patients who are financially burdened by medications at the core of the 340B program.

Financial Toxicity in Renal Patients (FINTORE) Study: A Cross-Sectional Italian Study on Financial Burden in Kidney Disease-A Project Protocol.

Financial toxicity (FT) refers to the negative impact of health-care costs on clinical conditions. In general, social determinants of health, especially poverty, socioenvironmental stressors, and psychological factors, are increasingly recognized as important determinants of non-communicable diseases, such as chronic kidney disease (CKD), and their consequences. We aim to investigate the prevalence of FT in patients at different stages of CKD treated in our universal health-care system and from pediatric nephrology, hemodialysis, peritoneal dialysis and renal transplantation clinics. FT will be assessed with the Patient-Reported Outcome for Fighting Financial Toxicity (PROFFIT) score, which was first developed by Italian oncologists. Our local ethics committee has approved the study. Our population sample will answer the sixteen questions of the PROFFIT questionnaire, seven of which are related to the outcome and nine the determinants of FT. Data will be analyzed in the pediatric and adult populations and by group stratification. We are confident that this study will raise awareness among health-care professionals of the high risk of adverse health outcomes in patients who have both kidney disease and high levels of FT. Strategies to reduce FT should be implemented to improve the standard of care for people with kidney disease and lead to truly patient-centered care.

High Financial Hardship among Patients with Advanced Ovarian Cancer

Ovarian cancer is considered the most fatal and costly gynecologic cancer. Although personalized therapies have improved ovarian cancer prognosis, they have resulted in increased financial toxicity concerns among this population. This study evaluated financial toxicity in patients with advanced ovarian cancer. Using secondary data from a study of barriers to palliative care, financial toxicity (FT) was measured through the Comprehensive Score for Financial Toxicity scale. Univariate and bivariate analyses were used to assess the relationship between selected demographic (i.e., age, race, ethnicity, education, place of birth, insurance type, yearly household income, employment status) and treatment-specific variables (i.e., years since diagnosis, surgery, chemotherapy, radiation, hormonal and targeted therapy) with clinically relevant financial toxicity. Characteristics were compared using Fisher’s exact or chi squared tests. A total of 38 participants with advanced ovarian cancer were included in this study; 24% (n = 9) reported clinically significant FT. Income (p = .001), place of birth (p = .048) and employment status (p = .001) were related to FT. Study findings highlight that advanced ovarian cancer patients experience high FT, particularly those with low income, who are not able to work and were born outside the US. Further research using larger datasets and more representative samples is needed to inform intervention development and implementation.

333 Financial Toxicity in Malignant Brain Tumors

INTRODUCTION: As costs for cancer care continue to rise, ongoing development of novel therapeutics have increased the number of patients living with cancer. Cancer survivors are at increased risk of having high medical debt burdens, bankruptcy, delayed treatments, poor compliance with therapy, and even death as a result of financial toxicity. METHODS: Hospital billing database was queried for patients with ICD code C71 who had a bad debt discharge (unpaid balance) on record from 2020-2022. The corresponding hospital chart was then queried for demographic data, patient factors, and clinical factors. RESULTS: 43 total patients had data available for analysis. The patient diagnoses were GBM (50%), Other (45.2%), followed by metastatic disease (4.7%). White patients had an average bad debt of $2742.10, while Black patients averaged $9851.6 (p = 0.017). 38.5% of White patients had more than $2000 in bad debt, compared to 81.8% of Black patients in that category (p = 0.014). The amount of debt differed significantly between tumor types; with 66.7% of GBM patients having more than $2000 in bad debt (p = 0.052). Difference in debt amount based on pre-operative employment status trended towards significance but fell short (p = 0.08). Most patients were unemployed (58.9%), followed by employed patients (33%), and retired patients (7.6%). 61.5% of employed patients had greater than $2000 in bad debt, compared with 56.5% of unemployed patients. 40% of patients had a pre-operative deficit, and of those patients, 54% had a bad debt amount in excess of $2000. 71% of patients without a pre-operative deficit had more than $2000 in bad debt. CONCLUSIONS: Bad debt is a major contributor to financial toxicity in patients with malignant brain tumors.

De novo financial toxicity in patients with prostate cancer following radical prostatectomy and its impact on health-related quality of life.

318 Background: Financial toxicity (FT), a patient-reported outcome measure (PROM) is defined as the detrimental impact of financial burden caused by a cancer diagnosis on a patient’s well-being. FT is common among cancer patients, yet little is known about FT following radical prostatectomy (RP) for prostate cancer in countries with universal health coverage. We aimed to assess de novo FT and its impact on health-related quality of life (HRQOL) in a large prospective cohort of patients undergoing RP with a systematic follow-up of up to 10 yrs. Methods: 2254 consecutive patients who underwent RP at a large tertiary care center were analyzed. PROMs were prospectively assessed preoperatively, postoperatively at 3mo, then annually until a maximum follow-up of 120mo, applying the validated EORTC QLQ-C30- and the prostate cancer-specific QLQ-PR25 questionnaires. FT was assessed by the “financial toxicity subscale” (FTS) of the EORTC QLQ-C30. Based on previous reports, meaningful FT was defined as FTS ≥ 17. Multivariable regression analysis was used to identify predictors for the development of de novo FT. Separate modeling of longitudinal HRQOL was performed for patients with de novo FT (FT-cohort) and without FT (no-FT-cohort). General HRQOL was assessed by the global health status domain (GHS) of the EORTC QLQ-C30. Results: 298 patients reporting FT prior RP were excluded from further analysis. 20.3% (n=397) of the included patients reported de novo FT within 12 months after RP with a mean FTS-score of 47.3 (SD 21.9). Baseline clinicopathological characteristics did not differ between the FT-cohort and the no-FT-cohort (p-range .060-.173). Multivariable logistic regression analysis revealed subsequent therapies following RP (OR 1.981, 95%CI 1.11-3.53, p=.020), low preoperative emotional functioning (OR 0.990, 95%CI 0.92-0.99, p=.031) and low preoperative social functioning (OR 0.990, 95%CI 0.98-0.99, p=.035) to independently predict development of de novo FT after RP. In longitudinal analysis, significantly worse general HRQOL was observed for patients with de novo FT postoperatively and up to 48mo after RP (p-value each &lt; .001). In the longer term, both cohorts reported no significant difference in general HRQOL up to 10yrs post RP (p-range: .90 - .91). Conclusions: The current study provides prospective data from a unique contemporary patient cohort, which reveals independent predictors for de novo FT in prostate cancer patients following RP. Furthermore, it displays the natural course of general HRQOL for patients who develop de novo FT.

Digital Health Literacy in Patients with Non-Hodgkin Lymphoma: Informing Intervention Approaches to Address Financial Toxicity

Introduction: Financial toxicity is the harmful effect of treatment costs on a patient's quality of life. Financial toxicity is common among cancer patients, and patients with hematologic malignancies often report worse financial toxicity than patients with other cancers. Thus, interventions to address financial toxicity in patients with hematologic cancers are urgently needed. Promising approaches include the use of digital media such as websites and educational videos. However, digital interventions may not be accessible for patients with low digital health literacy (DHL; the capacity to find and understand health-related information using electronic media). Information about DHL in patients with blood cancers is needed to inform future interventions addressing financial toxicity and other quality-of-life related issues. Here, we present a mixed-methods study describing DHL and its correlates among patients with non-Hodgkin lymphoma (NHL) who participated in a larger study about financial toxicity. Methods: Patients who received systemic therapy for NHL within the last year (N=50) participated in a cross-sectional study about the financial impact of cancer. Participants self-reported financial toxicity (Comprehensive Score for Financial Toxicity; COST) and digital health literacy (electronic Health Literacy Scale; eHEALS). They also rated whether they would consider using online tools to manage cancer-related expenses or communicate with their team about financial concerns, if offered in the future (yes, maybe, no). A subset of survey participants (n=13) completed a follow-up qualitative interview. Survey participants were purposively selected for interviews based on self-reported financial toxicity. Independent-samples t-tests, ANOVA, and correlations were used to test relationships between financial toxicity, DHL, sociodemographic factors, and patient preferences for intervention modalities/approaches. Rapid qualitative analysis was used to summarize participants' suggested modalities for financial toxicity interventions. Results: In this convenience sample of participants with NHL, participants were primarily older adults (median age 66, IQR 58-72.5), male (62%), and white/Caucasian (80%), with some college or more education completed (76%). The mean COST score was 28.0 (SD= 11.6, range: 0-44), with 32% reporting significant financial toxicity (COST score &amp;lt; 17.5). The mean eHEALS score was 24.6 (SD= 8.10, range: 8-40), and DHL did not vary significantly by age, gender, race/ethnicity, or household income (all p-values &amp;gt; 0.05). There was not a statistically-significant association between financial toxicity and DHL (r=0.028, p=0.849). However, DHL varied according to participants' preferences for online tools (Figure 1). Those who were interested in using online tools to manage cancer-related expenses reported higher DHL than those who were not interested(F(2,47)=5.43, p=0.007); there was a similar pattern for those interested in an online tool to communicate with their care teams (F(2,47)=5.73, p=0.006). Qualitative interviews (n=13) provided additional context for preferred formats for financial toxicity intervention preferences. For example, when asked about the best format for financial toxicity interventions, participants with higher levels of DHL suggested websites and phone applications, whereas participants with lower DHL levels suggested non-electronic modalities. Comfort level and barriers for utilizing technology-based interventions were also explored. Conclusions: A subset of NHL patients experiences financial toxicity, which does not appear to be directly related to DHL. Because DHL varies among patients with NHL, it may be important to risk stratify populations by DHL to appropriately focus and design tools for addressing financial toxicity. Patients with lower DHL may prefer other intervention modalities (e.g., written materials) and/or may benefit from additional support to access digital media interventions. Inclusion of participants with lower DHL levels in the early stages of intervention development may help to ensure that the most appropriate and usable tools for supporting patients with NHL are developed. Additional research is needed to better understand influences and correlates of DHL in patients with hematologic malignancies as well as the best approaches to financial toxicity interventions.

Trends of cancer drug cost increases and impact of generic and biosimilar drug launches.

19 Background: Drug cost increases are key contributors to cancer care spending in the US. These increases often outpace consumer price index (CPI) inflation, and impact patient access, outcomes, and cost sharing. We analyzed pricing trends and impacts of lower cost generic or biosimilar alternative (LCA) drug launches for key cancer drugs. Methods: Using Medicare Part B drug (Part B) administration &amp; Part D drug (Part D) dispense data for 15 practices in The US Oncology Network, we obtained the unit cost to Medicare for top 30 drugs by total spend over a 6-year period (July 2016 – June 2022). Evaluating cost change patterns in Part B and Part D, we compared trends before and after LCA launches. Results: Over a 6-year period, mean drug costs increased by 12.3% (range: -41.8% to 39%) for Part B and 46.2% (range: -67.5% to 278.2%) for Part D. The largest increases were for Protein-bound Paclitaxel (Part B) (39%) and Ibrutinib (Part D) (278.2%). Many increases exceeded CPI inflation (23.2%) over the same period. Part B/Part D drugs with LCA launches had decreases of -11%/-39%. Non-LCA Part B/Part D drugs increased 21%/ 67%. Prior to LCA launches, Part B/Part D LCA drugs had a mean increase of 22%. After LCA launches, a mean decrease of 36% was observed. Conclusions: Part D drugs have 3.75 times higher increases versus Part B and often outpace CPI inflation. LCAs for branded drugs bend cost increase trends. The impacts of evergreening drug patents and potential shifting of drug coverage from Part B to Part D on costs are ripe for evaluation. The inflation-based rebate and Part D coverage changes in the Inflation Reduction Act (IRA) need to be monitored for its impact on cancer drug cost trends, access, affordability, and financial toxicity for patients. [Table: see text]

Is financial toxicity associated with delays in diagnosis in gynecologic cancers?

119 Background: Patients with gynecologic cancer and high financial toxicity (FT) are significantly more likely to report delaying care than patients with low FT. We compared time of symptoms onset to diagnosis and treatment stratified by FT in patients with gynecologic cancer. Methods: Patients with gynecologic cancer completed a cross-sectional survey at follow-up visits with gynecology oncology providers from 2017-2021. The survey included the Comprehensive Score for Financial Toxicity (COST) tool. Data were abstracted from medical records, including dates of symptom onset, initial biopsy, surgery and/or start of relevant treatment. FT was categorized as high (COST score ≤23) and low (COST score &gt;23). Data are presented as n (%) and median (interquartile range). Results: There were 258 respondents, 54% with uterine cancer, 30% with ovarian and 16% with cervical. High FT was reported by 31% and low FT by 69%. Median age at diagnosis was 62 (53.8-69.9) years, 81% of respondents were Non-Latinx White, and 7% had a non-English primary language. Most cancers were stage I (59%), 10% stage II, and 31% stages III-IV. Most patients had surgery (91%), 50% had chemotherapy and 45% had radiation; 15% had recurrence. Median time of COST score since diagnosis was 13.6 months (5.7-41.1). Risk factors for high FT included age, race and ethnicity, education, employment, insurance status, income, and chemotherapy (all p&lt;0.05). Median time from symptom onset to diagnosis in all gynecologic cancers was longer in the high FT [3.1 (1.1-5.8) months] compared to the low FT [1.8 (0.9-3.8) months] group (p=0.01). Time from biopsy to gynecologic oncology consult and time from consult to surgery did not differ based on FT (both p&gt; 0.05). Among patients with cervical cancer, those with high FT had a longer median time from symptom onset to diagnosis [5.0 months (3.1–8.8)] compared to those with low FT [1.7 months (0.9–3.7); (p=0.04)]. Similarly, patients with uterine cancer and high FT had longer median time from symptoms onset to diagnosis [3.0 months (1.0–6.4)] than those with low FT [1.8 months (0.9–3.8); p=0.03]. In patients with ovarian cancer, time from symptom onset to diagnosis was not significantly different based on financial toxicity (p&gt;0.05). Conclusions: Patients with uterine and cervical cancer who reported high FT had a longer time to diagnosis compared to patients with low FT. Delays in accessing care, initial evaluation and treatment may contribute to worse cancer outcomes and survival for patients with FT as reported in other studies. More work is needed to understand what financial and social factors lead to the longer time to diagnosis in patients with uterine and cervical cancer.