2328 - Prospective, Longitudinal Assessment of Financial Toxicity and Emotional Well-Being for Women with Gynecologic Cancers Receiving Radiotherapy
Presenter(s)
M. Brown1, J. Gaskins2, M. Pisu3, C. Cooper4, K. Heinzman4, M. Liang5, A. M. McDonald1, S. Marcrom6, M. Soike1, R. Arend7, J. Rothe8, D. Hamer8, R. Hayes8, C. Humphrey8, S. Rhodes1, J. Richardson1, and M. B. Yusuf1; 1Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, AL, 2Department of Bioinformatics and Biostatistics, School of Public Health and Information Science, University of Louisville, Louisville, KY, 3University of Alabama at Birmingham, Division of Preventive Medicine, Birmingham, AL, 4University of Alabama at Birmingham, Birmingham, AL, 5Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA, 6Department of Radiation Oncology,University of Alabama at Birmingham, Birmingham, AL, 7Division of Gynecologic Oncology, University of Alabama at Birmingham Hospital, birmingham, AL, 8University of Alabama at Birmingham, birmingham, AL
Purpose/Objective(s): Patients (pts) with gynecologic cancers receiving radiation (RT) may be at higher risk of financial toxicity (FT). How FT affects emotional well-being (EWB, including meaning and purpose (MaP), anxiety and depression) and adherence to RT is unclear. As such, we performed a single-site pilot study designed to determine feasibility of recruiting pts with retention over three timepoints (pre-RT, end of RT, 3 month follow up (3mfu)): for characterization of the aforementioned. Exploratory objectives included assessment of FT and components of EWB, coping strategies, interventions used to mitigate FT, and factors associated with (a/w) missed RT.
Materials/Methods: Informed by prior studies, we estimated 50% of eligible pts would be recruited with 75% retained. Spearman’s ? was used to test associations between FT (defined using COST 2.0), EWB (defined using PROMIS anxiety 7a, depression 8a, and MaP 8a short forms) at each timepoint. Coping strategies (i.e., patient-reported sacrifices due to costs) and pt-level interventions (i.e., use of lodging, transportation, and medication assistance) were assessed. Wilcoxon tests were used to compare longitudinal changes within domains. Spearman’s ? was used to test associations between domains at each timepoint, and to test relationships between changes in domains over time (i.e. relationship between changes in FT over time and corresponding changes in EWB). Spearman’s ? was used for univariable testing of factors a/w missed RT, end of RT FT, 3mfu FT, and change in FT (3mfu relative to pre-RT).
Results: Of 52 eligible pts, 50 pts were enrolled (96.2%, from 7/2023-4/2024), with 43 of 50 (86%) retained over the three timepoints. Most patients had cervical (38%) or uterine cancer (38%). The majority of pts had advanced disease (78% stage III/stage IV at diagnosis, 42% with metastatic disease at enrollment). The median RT fraction (fx) number was 13 (range 1-36). Severe baseline FT was prevalent (COST <=15, 33%). Baseline FT, and EWB was correlated with end of RT and 3mfu assessments (p <0.001). Higher baseline FT was a/w higher baseline anxiety, higher depression and lower MaP (p values <=.002). No significant change in FT was noted for the overall cohort over time (p=.29). Worsened FT (end of RT relative to pre-RT) was a/w decreased MaP (p =.003). Age, income, marital status, employment and insurance type were a/w baseline FT (p <0.05). 22 (51%) pts reported decreased spending on food and 7 (16%) pts reported delayed/unfilled prescriptions at 3mfu. Pt-level interventions were not a/w change in FT (3mfu relative to pre-RT, p =0.99). 19 (38%) pts had = 1 missed RT fx, baseline EWB (higher anxiety and depression, lower MaP) was associated with higher risk of missed RT (p <0.05).
Conclusion: This suggests relationships exist between FT and EWB, which may affect adherence to RT. Future studies of interventions for FT may benefit from inclusion of larger cohorts with diverse cancer types, hospital/system level deployment and EWB consideration.