Financial Toxicity Research Articles

Financial toxicity among gynecologic oncology surgical patients

Financial toxicity among gynecologic oncology surgical patients

Geospatial insights into social determinants and financial toxicity among patients with gynecologic malignancies: A perspective from the American Community Survey data

Geospatial insights into social determinants and financial toxicity among patients with gynecologic malignancies: A perspective from the American Community Survey data

Financial toxicity in gynecologic oncology and its impact on medication access, debt, and food insecurity

Financial toxicity in gynecologic oncology and its impact on medication access, debt, and food insecurity

ASO Author Reflections: Young Adults and Racial Minorities May Be at High Risk for Financial Toxicity After Breast Cancer Treatment.

ASO Author Reflections: Young Adults and Racial Minorities May Be at High Risk for Financial Toxicity After Breast Cancer Treatment.

Financial toxicity associated with obtaining childcare while undergoing therapy for gynecologic malignancies

Financial toxicity associated with obtaining childcare while undergoing therapy for gynecologic malignancies

Evaluation of a novel screening program for financial toxicity among gynecologic oncology patients at initial consultation

Evaluation of a novel screening program for financial toxicity among gynecologic oncology patients at initial consultation

When toxicity is not just from gluten: a systematic review on financial toxicity and celiac disease

Abstract Background With an incidence of up to ∼2% globally, Celiac Disease (CD) is probably one of the most life-long common chronic conditions. Although ‘Financial toxicity’ (FT) has been mainly linked to oncology, significant financial burdens have been described across all healthcare domains, even in CD and to the unexpected economic effort resulting from illness and the need for treatments. This study aimed to investigate the potential relationship between CD and FT. Methods A systematic literature review was performed according to the PRISMA Statement 2020 guidelines. The search query queried the following databases: PubMed, Scopus, CINAHL and APA PsycInfo. No time and study design limits were included. Results 105 articles were found, and 25 were included in the review. The main results revealed that CD impacts physical health and imposes a significant financial burden on patients and their families. FT in CD is primarily due to the high costs of diagnosis, lifestyle changes, and expenses for gluten-free foods. Several studies highlighted the scarce adherence to the therapeutic diet due to the cost of food and poor acceptance of CD. Furthermore, since 2007, there has been increased attention to the difficulty of finding gluten-free products and their expensive fees. All these aspects, even for low-income countries, were faced differently globally, as documented by the heterogeneity of government subsidy policies highlighting the health inequity. Conclusions Considering the prevalence, a comprehensive health assessment with a global health approach should consider clinical, social, and economic aspects. This regard could improve the quality of life for CD patients and ensure fair and personalised access to care, regardless of their geographical location or financial situation. This review has highlighted the fragmentation of resources available internationally, underlining the relevance from a public health point of view. Key messages • Celiac Disease is one of the most common life-long disorders, and financial toxicity is an aspect that should be taken into account also from a public health point of view to ensure health equity. • The gluten-free diet represents an important therapeutic choice in CD; the related expensive fees could increase scarce adherence and worse health outcomes.

Factors Associated with Unmet Supportive Needs in Adult Cancer Survivors in South Korea

Abstract Purpose As the number of cancer survivors increases, addressing their unmet supportive care needs (USCNs) has become crucial. This study aimed to evaluate the influence of financial toxicity on USCNs and identify comprehensive factors associated with USCNs among adults’ cancer survivors. Methods A cross-sectional survey using convenience sampling from the 2022 Korean Population Census. Data were collected online between November 17 and December 15, 2022. The study included 1,038 cancer survivors aged 19 years or older who had completed primary treatment. Multivariable logistic regression was analyzed to identify factors associated with USCNs. Results Two-thirds (65.7%) of cancer survivors experienced severe financial toxicity, correlating with high unmet supportive care needs. Among those who reported a severe financial burden, a substantial 170 out of 187 respondents, or approximately 90.9%, were identified as having high unmet supportive care needs. Cancer survivors had the highest needs in the order of ‘management of psychological symptoms’ and ‘coping and emotional needs’. Cancer survivors diagnosed between 5 and 10 years ago were found to be less likely to report unmet supportive care needs compared to those diagnosed more recently, with an odds ratio of 0.14. Additionally, breast cancer survivors and individuals who were unemployed at the time of diagnosis had a higher likelihood of experiencing unmet supportive care needs, with adjusted odds ratios of 1.68 (95% confidence interval: 1.088-2.603) and 1.80 (95% CI: 1.125-2.891), respectively. Conclusions Cancer survivors with moderate to severe financial distress were more likely to be at risk of experiencing a high level of unmet supportive care needs. Coping and emotional needs are the most important concerns among the unmet needs of cancer survivors regardless of the time since cancer diagnosis. Key messages • Cancer survivors in South Korea with moderate to severe financial distress are twice as likely to face a high level of unmet supportive care needs. • The most significant unmet supportive care needs among South Korean cancer survivors relate to coping and emotional support, highlighting the need for enhanced mental health services.

Cancer survivorship and long-term outcomes: navigating the challenges beyond treatment

The increasing number of cancer survivors due to advancements in early detection and treatment has shifted the focus of oncology to the long-term health and well-being of these individuals. Cancer survivorship encompasses a wide range of challenges that extend beyond the completion of treatment, including physical, psychological, social, and economic issues. This review explores the long-term physical health consequences of cancer treatment, such as neuropathy, cardiotoxicity, and chronic conditions, and highlights the psychological burdens, including anxiety, depression, and cognitive impairment, commonly faced by survivors. The article also addresses the social and economic impacts, such as difficulties in returning to work and financial toxicity, which further complicate the survivorship experience. Additionally, the review emphasizes the importance of assessing and improving the quality of life (QoL) for survivors through personalized interventions and the implementation of survivorship care plans (SCPs). Emerging research on biomarkers, telemedicine, and policy advocacy is discussed as critical components for advancing survivorship care. The review concludes that a comprehensive approach, including ongoing research, personalized care, and supportive policies, is essential to meet the diverse needs of cancer survivors and improve their long-term outcomes and QoL.

Validity, test-retest reliability, and responsiveness of the Indonesian version of FACIT-COST measure for subjective financial toxicity.

Financial toxicity describes the impairment of financial wellbeing in patients due to the burden of cancer diagnosis and care. The COST: A Functional Assessment of Chronic Illness Therapy Measure of Financial Toxicity (FACIT-COST) is the most widely used cancer-specific measure of subjective financial toxicity, having been validated in multiple languages, but not in Indonesian. This study aimed to validate the Indonesian version of FACIT-COST in a breast cancer sample. A single-center prospective cohort study was performed in Indonesia. Female breast cancer patients aged ≥ 18 undergoing treatment at baseline were invited to participate and followed for up to six months. The survey included the official Indonesian version of FACIT-COST (v2) which was administered to the patients by interviewers. Clinical information (e.g., metastasis status, disease duration) was provided based on medical records. The following measurement properties of FACIT-COST were tested: distributional characteristics, structural validity (principal component [PCA] and confirmatory factor analyses [CFA]), internal consistency reliability (Cronbach's alpha and McDonald's omega), known-groups validity (Mann-Whitney U or Kruskal-Wallis H test), test-retest reliability, and responsiveness to change. Overall, 300 female patients participated at baseline. No patients reported the best or worst possible FACIT-COST total scores. The PCA proposed a two-factor model structure for the instrument, which was confirmed by the CFA (RMSEA = 0.042, SRMR = 0.049, CFI = 0.99, TLI = 0.99). The internal consistency reliability of the two factors was considered adequate (Cronbach's alpha = 0.774-0.882, McDonald's omega = 0.786-0.888). The FACIT-COST total score significantly discriminated across the following known-groups: age, education, residential setting, income, employment, metastasis status, number of symptoms, and financial coping strategies. The FACIT-COST demonstrated excellent test-retest reliability (intraclass correlation coefficient = 0.96) and satisfactory responsiveness to change (standardized response mean and effect size ranges=|0.39| to |0.92|). This is the first study to validate the FACIT-COST in patients with breast cancer and to present the measurement properties of the Indonesian version of FACIT-COST. The Indonesian FACIT-COST demonstrates acceptable psychometric performance and shows potential as a valid measure of subjective financial toxicity. The instrument may serve as a valuable tool for informing health policies that focus on providing resource support to improve cancer care in Indonesia.

Worse Psychological Profiles Are Associated With Higher Levels of Stress and Symptom Burden in Patients With Cancer During the COVID-19 Pandemic.

To identify subgroups of patients with distinct psychological profiles at the beginning of the COVID-19 pandemic and evaluate for differences. Online survey of patients with cancer during the COVID-19 pandemic. Patients completed measures of demographic and clinical characteristics, as well as cancer- and COVID-19-related stress, global stress, social isolation, loneliness, financial toxicity, and common symptoms. Latent profile analysis was used to identify distinct psychological profiles. Among 1,145 patients, three subgroups were identified (i.e., no anxiety or depression and normative level of resilience; high depression, high anxiety, and low resilience; and very high depression, very high anxiety, and very low resilience). Patients with the two worst psychological profiles were younger, more likely to be female, more recently diagnosed with cancer, and more likely to have breast cancer. Findings may assist clinicians to identify patients at increased risk for significant psychological morbidity and provide more timely, targeted, and cost-effective interventions.

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.

A Phenomenological Approach to Financial Toxicity: The-Economic-Side Effect of Cancer.

The economic burden of chronic diseases such as cancer could negatively impact patients' health and quality of life. The daily management of the disease results in economic needs that patients often face directly, which may lead to real toxicity, just defined as financial toxicity. This study aims to explore cancer patients' experiences, emotions, opinions, and feelings related to the phenomenon of financial toxicity. A phenomenological qualitative descriptive study was conducted through face-to-face interviews with adult oncological patients. The sample (n = 20) was predominantly composed of females (with a meanly 58 years old) with breast cancer and in chemotherapy treatment. The most relevant topics that emerged from the patients' experiences were the impact on work, the distance from the treatment centre, the economic efforts, the impact on the quality of life, and the healthcare workers' support during the healthcare pathway. From the phenomenological analysis of the interviews, three main themes and seven related subthemes emerged. This study provided a phenomenological interpretation of financial toxicity in adult cancer patients and underlines that this issue involves families or caregivers, too. Financial problems appear relevant for those who experience cancer and should be included in a routine assessment by healthcare professionals.

Financial toxicity in early-phase cancer clinical trial participants.

Little is known about financial toxicity in early-phase clinical trial (EP-CT) participants. This study sought to describe financial toxicity in EP-CT participants and assess associations with patient characteristics and patient-reported outcomes (PROs). Prospectively enrolled EP-CT participants from were followed from April 2021 through January 2023. Participants completed the Comprehensive Score for Financial Toxicity (<26=financial toxicity) at time of treatment. Quality of life (QOL), symptoms, coping, and resource concerns were surveyed. Associations of financial toxicity with patient characteristics, PROs, and clinical outcomes were explored. Of 261 eligible patients, 197 completed baseline assessments (75.5%, median age=63.4 years [31.8-88.6], 57.4% female). Most common cancers were gastrointestinal (33.0%) and breast (20.8%). More than one third (34.0%) of patients reported financial toxicity. Patients with financial toxicity were more likely to be<65 years (70.2% vs 48.5%, p=.004), unemployed (45.5% vs 16.9%, p<.001), not have attended college (53.1% vs 26.4%, p=.002), and have income <$60,000 (59.7% vs 25.4%, p<.001). In adjusted models, patients with financial toxicity reported lower QOL (B=-6.66, p=.004) and acceptance (B=-0.78, p=.002), and increased self-blame (B=0.87, p<.001). They were more likely to have concerns regarding housing (10.6% vs 2.3%, p=.025), bills (31.8% vs 3.8%, p<.001), food (9.1% vs 0.8%, p=.006), and employment (21.2% vs 1.5%, p<.001). There was no difference in time on trial (hazard ratio, 1.03; p=.860) or survival (hazard ratio, 1.16; p=.496). More than one third of EP-CT participants reported financial toxicity. Factors associated with financial toxicity and demonstrated novel associations among financial toxicity with QOL, coping, and resource concerns were identified, highlighting the need to address financial toxicity among this population.

Updates in palliative care of gynecologic oncology patients

Purpose of review This review assesses the impact of early integration of palliative care and the disparities that exist among patients with gynecologic malignancies. It also highlights the recent advances in symptom management, goals of care communication, and end of life care. Recent findings Although palliative care has been utilized earlier, there are still barriers to its integration both nationally and worldwide, manifesting as predominantly late hospice referrals and aggressive care at the end of life. However, there are increasing efforts to promote earlier integration and discussion around goals of care through multidisciplinary approaches. Apart from symptom burdens, patients with gynecologic malignancies experience financial toxicity that impact various aspects of their lives, leading to potentially harmful choices to mitigate costs. A growing area of interest in palliative care is the realm of psychedelic-assisted therapy, which has shown benefits in treating advanced cancer patients with depression. Summary While significant strides have been made in incorporating palliative care earlier, continued research in palliative care is needed to address symptomatic and psychosocial suffering worldwide.

Association between food insecurity, financial toxicity, and healthcare utilization in adolescents and young adults with cancer.

305 Background: Adolescents and young adults with cancer experience high rates of financial toxicity (FT) and unmet health-related social needs (HRSN: food, housing, transportation insecurity). FT and unmet HRSN, specifically FI, are modifiable factors that impact health outcomes; however, the relationship between FI, FT, and healthcare utilization (emergency department (ED) visits or hospitalizations) remains unclear. Leveraging systematic screening for FT and HRSN using the electronic health record (EHR) patient portal among AYAs with cancer, we examined the association between FI, FT, and healthcare utilization measures among AYAs with cancer. Methods: AYAs (ages 15-39) who utilize the EHR patient portal were prompted to complete an 8-item standardized HRSN survey (i.e., food insecurity, housing instability, transportation difficulties) and a 2-item previously established FT survey during e-check in between November 2022 and April 2024. ED visits and hospitalizations were extracted from the EHR directly. Descriptive statistics and associations using chi-square tests were used to describe the patients and examine associations between FI or FT and ED visits or hospitalizations. Results: Of 691 AYAs who completed the HRSN survey, 16% (n=109) screened positive for FI. Among AYAs with FI, 42% (n=46) had at least one ED visit compared with 28% (n=163) among AYAs without FI (p&lt;0.01). Among AYAs with FI, 39% (n=43) were hospitalized at least once compared to 31% (n=179) among AYAs without FI (p=0.07). Of 439 AYAs who responded to the FT survey, 66% (n=290) met criteria for high FT. Within this group, 26% (n=74) had at least one ED visit compared with 17% (n=26) who screened negative (p=0.06). Among AYAs with high FT, 22% (n=65) were hospitalized at least once, compared with 19% (n=28) among those with low or moderate FT (p=0.38). Among 384 AYAs who responded to both the HRSN and FT surveys, 19% (n=74) screened positive for FI, 92% (n=68) of whom also had high financial toxicity. The table describes characteristics of screened AYAs by language and race/ethnicity. Conclusions: FI may be a risk factor for increased ED visits during cancer treatment among AYAs. Systematic screening to identify FI, FT, and other HRSN is important to facilitate referral for resources, support services, or interventions. Sociodemographic characteristics of AYA participants in FI and FT screening. Characteristic +FI -FI +FT -FT N=109 (%) N=582 (5) p-value N=290 (%) N=149 (%) p-value Language &lt;0.01 &lt;0.01 English 82 (75) 496 (85) 241 (83) 134 (90) Spanish 24 (22) 45 (8) 29 (10) 1(1) Other 3 (3) 41 (7) 20 (7) 14 (9) Race/Ethnicity &lt;0.01 &lt;0.01 Hispanic, any race 67 (61) 175 (30) 125 (43) 16 (11) Non-Hispanic Black 12 (11) 62 (11) 30 (10) 10 (7) Non-Hispanic White 16 (15) 219 (38) 78 (27) 84 (56) Other 14 (13) 126 (22) 57 (20) 39 (26)

Financial toxicity and unmet social needs in adolescents and young adults (AYA) with cancer.

13 Background: Cancer incidence is rising in adolescents and young adults (AYA) (age 18-39), a population that faces durable financial challenges during and after treatment. Although AYA cancer survivors face unique risks for poor outcomes due to financial toxicity (FT), best practices for FT and social needs screening (i.e. food, housing, transportation insecurity) are unknown. Further, the relationship between FT and social needs is largely unexplored in AYA. Methods: A FT and social needs screening quality improvement project was conducted at a comprehensive cancer center. The Comprehensive Score for Financial Toxicity (COST) assessed FT, and patients reported unmet social needs and treatment payment methods. Quality of life (QOL) was assessed via a visual analog scale. Multivariate linear and logistic regression tested for associations with FT and unmet social needs, adjusting for demographic and clinical characteristics. Results: Of 70,983 requests, 38,249 patients completed the screening (54% response rate): 2,519 were AYA. Mean age of AYA was 33.7 years (SD 4.7), and most (65%) were non-Hispanic white. Disease sites included 41% breast, 20% gastrointestinal, and 19% gynecologic. Over one-half (54%) had active cancer treatment (chemotherapy, radiation, or surgery) within 120 days of assessment. Mean COST was 23.2 (SD 10.8; 0-44, with lower scores indicating worse FT), and 54% had COST &lt;26, suggesting FT. Racial/ethnic minority patients (β -4.37, p&lt;0.001) and those who had recent treatment (β -3.21, p&lt;0.001) had worse FT. Of those who screened positive for FT, only 44% accepted a referral for financial assistance. About one-quarter of the sample (28%) were unable to afford at least one social need, with 16% facing housing, 14% transportation, and 13% food insecurity. Patients who are a racial/ethnic minority (OR 2.98, 95% CI 2.35-3.79, p&lt;0.001) and those with metastatic disease (OR 2.45, 95% CI 1.10-5.45, p=0.028) were more likely to have at least one unmet social need. One-quarter of the sample (24%) used at least some of their savings to pay for treatment, with 7% reporting they did not have any savings. 25% borrowed money or took on new loans to pay for treatment: of those, 58% borrowed from friends/family. 10% did not have enough money for medications, and 7% took less medications than prescribed due to cost. Mean QOL was 7.3 [(SD 1.8) 0 “as bad as it can be”-10 “as good as it can be”]. Increased FT was associated with reduced QOL (β -0.10, p&lt;0.001), using more savings to pay for treatment (β 0.52, p&lt;0.001), and taking less medications due to cost (β 0.01, p&lt;0.001). Conclusions: Routine FT and social needs screening is feasible for AYA patients and uncovers high rates of FT and unmet social needs. Given lower QOL and decreased adherence to treatment associated with FT, future research should focus on interventions to support the specific needs of AYA and increase acceptance of financial assistance and navigation.

Longitudinal outcomes after financial toxicity and health-related social risks screening and referral.

17 Background: Financial toxicity (FT) is associated with delayed/omitted care, reduced quality of life, and worse mortality. Routine screening for FT and health-related social risks (HRSR) is recommended during clinical care, but there is limited longitudinal evidence on outcomes after patients screen positive and are referred for assistance. Methods: FT and HRSR screening for patients with breast, gynecologic, gastrointestinal, or thoracic cancers was implemented at an urban comprehensive cancer center. Screening included the Comprehensive Score for Financial Toxicity (COST) tool (0-44, lower scores=worse FT) and a HRSR checklist to identify food, housing, and transportation insecurity. COST score ≤16-20 or reported HRSR was a “positive” screen and counseling referral was offered: patients could accept the referral by identifying their current concerns. Analysis sample was limited to receiving chemotherapy, radiotherapy, or surgery 120 days prior to baseline survey and had a follow-up survey 4-12 months later. Data were collected 10/2022-12/2023. Results: 2196 patients met inclusion criteria, median time between surveys was 5.5 months (IQR 4.4, 6.9). 20% (n=438) screened positive and accepted referral; 11% (n=246) screened positive and declined referral; the remaining 69% (n=1512) screened negative. Sociodemographic factors of age (median 58 vs 62, p&lt;.001), sex (82% vs 74% female, p =.015), and race (31% vs 17% racial/ethnic minority, p&lt;.001) were associated with accepting vs declining referral. Those who accepted referral had lower COST scores (median 10 vs 19) and more HRSR (39% vs 20% housing; 32% vs 18% food; 37% vs 17% transportation) at baseline (all p≤.001). At follow-up, both cohorts had COST decrease, indicating worsened FT [mean difference (95% CI): accepted referral -2.0 (-2.8, -1.2) vs declined referral -2.8 (-4.0, 1.5)]. Across all collected HRSR, those who accepted referral had small benefits in previously reported HRSR, however were more likely to have newly designated HRSR (Table shows changes). Conclusions: Screening for FT and HRSR identified one-third of patients on recent cancer treatment with financial or social needs. Those who accepted financial assistance referral had significantly higher FT and more reported HRSR. Although referral did appear to have some benefit on initial needs, new HRSR were identified at follow-up. Future work will focus on optimizing available assistance to meet ongoing patient needs during and after cancer treatment. Accepted Referraln = 438 (%) Declined Referraln = 246 (%) Housing Resolved need 67 (15) 31 (13) New need 54 (12) 15 (6.1) Stable unmet need 102 (23) 18 (7.3) Stable no need 215 (49) 182 (74) Food Resolved need 64 (15) 31 (13) New need 69 (16) 16 (6.5) Stable unmet need 77 (18) 14 (5.7) Stable no need 228 (52) 185 (75) Transportation Resolved need 73 (17) 34 (14) New need 56 (13) 20 (8.1) Stable unmet need 87 (20) 8 (3.3) Stable no need 222 (51) 184 (75)

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 &lt; .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.

National survey of patient perspectives on medication costs among co-pay assistance recipients with cancer.

246 Background: Individuals with cancer may seek assistance from co-pay assistance programs (CAPs) to help with high medication costs. However, little is known about these individuals’ perspectives on medication costs and their associations with other patient-reported outcomes (PROs). Methods: From 10-11/2022, we conducted a national, cross-sectional survey of CAP recipients with cancer, which asked about patient perspectives on medication costs (knowing monthly spending on medications, belief that health insurance would prevent high medication costs, and inability to afford care even with help paying for medications). We fit logistic regression models to describe associations between patient characteristics, including patient demographics and PROs (depression/anxiety symptoms [PHQ-4], financial toxicity [COST tool, score &lt;14 indicates high financial toxicity], and health literacy [Brief Health Literacy Screener]), with patient perspectives. Results: Among 1,108 survey participants (median age=72 [range 41-92], 60% male sex), the most common cancer types were multiple myeloma (54%) and prostate cancer (13%). The majority of participants reported knowing their monthly spending on medications (75%); most believed their health insurance would prevent them from high medication costs (67%); under half reported an inability to afford care even with help paying for medications (41%). Factors associated with lower odds of knowing monthly medication spending included Black race (OR=0.45, P=.005), having Medicare Advantage (OR=0.73, P=.036), lack of supplemental insurance (OR=0.68, P=.011), more comorbidities (OR=0.52, P=.002), depression symptoms (OR=0.61, P=.013), and lower health literacy (OR=0.43, P&lt;.001). Factors associated with believing that health insurance would prevent high medication costs were depression symptoms (OR=1.54, P=.02), anxiety symptoms (OR=1.40, P=.045), and financial toxicity (OR=2.24, P&lt;.001). Factors associated with reporting an inability to afford care even with help paying for medications included Hispanic ethnicity (OR=2.55, P=.024), more comorbidities (OR=1.84, P=.003), depression symptoms (OR=3.16, P&lt;.001), anxiety symptoms (OR=3.60, P&lt;.001), and financial toxicity (OR=7.83, P&lt;.001). Conclusions: In this large sample of CAP recipients with cancer, most reported knowing their monthly medication spending, believing health insurance would prevent high medication costs, and feeling able to afford care with help paying for medications. We identified patient characteristics associated with these perspectives and found correlations between depression/anxiety symptoms, financial toxicity, and low health literacy with greater concerns with medication costs. Effort to mitigate financial toxicity by reducing adverse effects of medication costs in oncology should consider patients’ perspectives and their impact on PROs.