2469 - Financial Stress and Cost-Coping Behaviors Associated with Financial Toxicity among a Diverse Patient Population Undergoing Radiation Treatment
Presenter(s)
K. Sahani1, C. Hwang1,2, D. Reyes3, K. M. Esselen3, M. Hacker3, and J. W. Jang1; 1Department of Radiation Oncology, Beth Israel Deaconess Medical Center, Boston, MA, 2Department of Radiation Oncology, Tufts Medical Center, Boston, MA, 3Department of OB/GYN, Beth Israel Deaconess Medical Center, Boston, MA
Purpose/Objective(s): This was a survey study to identify financial stress and cost-coping strategies and behaviors that were associated with high FT for patients prior to undergoing radiation therapy.
Materials/Methods: All adult patients undergoing radiation therapy for any malignancy were eligible to participate. Patients were approached and asked to complete a baseline survey before the start of radiation therapy, with plans for additional surveys 1 month and 1 year after radiation. The survey included the Comprehensive Score for Financial Toxicity (COST) tool and questions on demographic and disease characteristics, financial stress, and cost-coping strategies. Lower COST scores indicate higher FT. High FT was defined as COST scores =22, which was the top tertile, and low FT was defined as >22. Chi-square and Fisher’s exact tests were used to compare the high and low FT groups and log-binomial regression was used to estimate risk ratios (RR) and 95% confidence intervals (CI. We used age, insurance, income and employment as potential confounders.
Results: Of 305 respondents, 40 were excluded for incomplete COST scores. Of 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. In comparison to patients with low FT, patients with high FT and their caregivers were significantly more likely to have decreased their employment, such as taken unpaid time off, stopped working or retired early (P <0.001). Patients with high financial toxicity (FT) were more likely to report that the cost of transportation or parking influenced their medical decisions (P <0.001). Additionally, medical bills and reduced work capacity significantly contributed to their financial stress (P <0.001). Patients with high FT were more likely to delay medical care (RR: 13, 95% CI: 4–43) and medical visits (RR: 12, 95% CI: 2–104). Patients with high FT also were more likely to borrow money (RR: 10, 95% CI: 4–26), use savings (RR: 3, 95% CI: 2–4), and reduce spending on basic goods (RR: 7, 95% CI: 3–16) and leisure activities (RR: 3, 95% CI: 2–5). Adjusting for age, insurance, income, and employment did not appreciably alter these associations.
Conclusion: High FT was strongly associated with financial stress, decisions to delay medical care, and cost-coping strategies, such as borrowing money or cutting back on essential goods—actions that can significantly compromise both patient outcomes and quality of life. Developing strategies to alleviate the financial burden during radiation treatment is crucial to preserving both quality of life and patient outcomes.