Financial toxicity in patients with gynecologic malignancies: a cross sectional study

Abstract

Objective To evaluate financial toxicity and assess its risk factors among patients with gynecologic cancers. Methods This is a cross sectional study that included 2 survey tools, as well as patient demographics, disease characteristics, and treatment regimen. Financial toxicity is measured by validated Comprehensive Score for Financial Toxicity (COST) tool. Participants were also asked to complete a 55-question-survey on attitudes and perspectives surrounding cost of care. Descriptive statistics was used to report patient demographics. Spearman's rank correlation was calculated to assess the relation between financial toxicity and patient/disease related variables. Graphpad Prism Software Version 8.0 was used for analyses. Results A total of 50 patients with various gynecologic malignancies were enrolled. Median COST score was 20.5 (range, 1–33). Sixty-five percent of the patients reported being in debt due to their cancer care and 4% filed bankruptcy. Correlation analysis showed that COST score was correlated with age (r=−0.3, p=0.028), malignancy type (r=0.3, p=0.039) and income (r=0.3, p=0.047). Ovarian cancer patients had significantly less financial toxicity (median COST score=23) when compared to patients with other gynecologic malignancies (median COST score=17, p=0.043). When scores were dichotomized into low (score ≥22) and high toxicity (score <22), 58% (29/50) of the patients were noted to have high financial toxicity. Enrollment to a clinical trial did not significantly alleviate financial burden. Conclusion Financial toxicity is a significant burden even among highly insured gynecologic oncology patients. Age, malignancy type and income were correlated with high financial burden.

Validity of the COmprehensive Score for financial Toxicity (COST) in patients with gynecologic cancer

“…Younger age, which was associated with a lower COST score,5 explains this difference. However, in comparison with other studies in the United States among gynecologic patients, the median COST scores were also lower (19 vs 29, 20.5, and 24) 18–20. Out-of-pocket costs were not associated with the COST scores in our study.…”

“…Our evaluations addressed the limited sample size and reproducibility, as discussed in the validation study of the Japanese version of the COST tool 5 14. The expansion of the concept of financial toxicity has led to more studies using the COST tool being published, including studies in the field of gynecologic oncology 18–20. Our results support the reliability of financial toxicity studies.…”

“…Based on the results and our results with many samples, financial toxicity exists in countries where patients have even small out-of-pocket medical costs, and the COST tool can quantify the financial toxicity. Financial toxicity cannot be assessed based on out-of-pocket costs because income and savings are factors associated with COST scores 5 11 19 20. Patients are rarely asked about their financial status.…”

“…The evaluation will provide key findings on financial toxicity in this study setting, such as patients during anti-cancer drug therapy or limited out-of-pocket costs. Several studies on gynecologic cancer regarding financial toxicity using the COST tool have been reported 18–20. To better understand financial toxicity and improve QOL, studies in various economic, insurance, and geographic settings and intervention studies to alleviate financial toxicity are necessary.…”

Insurance-based disparities and risk of financial toxicity among patients undergoing gynecologic cancer operations

“…Although gynecologic malignancies are common and responsible for an estimated $3.8 billion in annual expenditures [10], study of FT in this area has been limited to several single-institutional studies [11,12]. In a study of 308 gynecologic oncology patients, Esselen et al found nearly 50% of patients to be at risk for moderate to severe FT [12].…”