2383 - Assessment of Baseline Financial Toxicity and Associated Social Determinants of Health among a Diverse Patient Population Undergoing Radiation Treatment

Purpose/Objective(s): This was a survey study to identify social determinants of health, and personal and disease characteristics, that are associated with high FT among patients prior to undergoing radiation therapy.

Materials/Methods: All adult patients undergoing radiation treatment for any malignancy were eligible to participate. Patients were approached and asked to complete the survey before the start of radiation treatment. This was a baseline survey that is part of a prospective survey study in which patients also complete surveys one month and one year after radiation. The survey was in English; patients with other language preference completed the survey with assistance. The survey included the Comprehensive Score for Financial Toxicity (COST) tool and questions pertaining to demographic and disease characteristics, as well as social determinants of health. Lower COST scores indicate higher FT. High FT was defined as COST scores =22, which was the top tertile; low FT was defined as >22. Additional questions on employment, self-reported race and ethnicity, income, partnership status, loans, savings, education level, insurance status, and other cost-coping strategies were included. Chi-square, Fisher’s exact, and Wilcoxon rank-sum tests were used to compare the high and low FT groups.

Results: Of 305 respondents, we excluded 40 with incomplete COST scores. Among the remaining 265 respondents, the median (interquartile range) COST score was 16 (12-19) among those with high FT and 32 (27-37) among those with low FT. Compared to respondents with low FT, those with high FT were younger, more likely to self-identify as Asian, Black or Hispanic, and less likely to be married or partnered (all P =0.02). High FT also was associated with a lower education level, a primary language other than English, state-funded medical insurance, and lower household income (all P =0.004). High FT was associated with specific clinical factors, such as receipt of chemotherapy, and cancer type (gynecologic, thoracic, breast and other cancer types, both P =0.001). There was no significant difference in distance traveled for treatment (P =0.05) or total fractions of radiation received (P =0.06) between the high and low FT groups.

Conclusion: Specific baseline social determinants of health, along with personal and disease characteristics, help identify those patients with high FT at the start of radiation treatment, and could inform the development of patient-centered strategies to reduce financial burden. These efforts can improve quality of life and enhance adherence to life-saving cancer treatments. Future efforts include tracking FT over time for patients going through radiation therapy to assess how their financial burden evolves.