Factors Associated With Financial Toxicity After the Completion of Radiation Treatment Among Patients With Gynecologic Cancer

Katharine Esselen, MD, MBA, Beth Israel Deaconess Medical Center, Brookline, MA, United States, discusses a study she worked on that explores the factors that may predispose patients receiving radiation treatment for gynecologic cancer to experience increased financial toxicity.

This study was presented at the SGO 2022 Annual Meeting on Women’s Cancers.

Transcript:

Hello, my name is Kate Esselen. I am a practicing Gynecologic Oncologist at Beth Israel Deaconess Medical Center in Boston, Massachusetts. I'm also an Assistant Professor of Obstetrics Gynecology and Reproductive Biology at Harvard Medical School. I'm very thankful to Journal of Clinical Pathways for the opportunity to share with you a brief synopsis of our study entitled, Factors Associated with Increased Financial Toxicity After the Completion of Radiation Treatment for Gynecologic Cancer. This was recently presented at the SGO Annual Meeting on Women's Cancer in Phoenix, Arizona, in March of 2022.

Financial toxicity is now a well recognized adverse outcome of cancer care that can negatively impact personal wellbeing, health related quality of life, and health outcomes. It encompasses both the material financial burdens, as well as the subjective financial distress, that patients experience as a result of their diagnosis. In a survey study that we and others performed in the past, we have learned that up to 50% of gynecologic cancer patients experience significant financial toxicity that is associated with worse quality of life, and that those with high financial toxicity are more than seven times as likely to report delaying or avoiding their medical care. Further, patients with severe financial toxicity are more than four times as likely to report non-adherence to their recommended medications.

Given these findings, we felt it was incredibly important to continue to try to understand financial toxicity in our gynecologic cancer patients. Radiation treatment poses unique stressors on cancer patients due to the sort of intensive treatment that has its own direct medical costs, as well as many indirect costs, such as increased parking and transportation costs, and potentially decreased employment or lost wages due to the treatments themselves or side effects.

Many prior studies have shown that systemic chemotherapy or therapy may be a risk factor for financial toxicity. However, very little is known, or has been studied yet, about the association between radiation treatments and financial toxicity. Plus, in our current study, we sought to assess the burden of financial toxicity in a population of patients who had recently completed radiotherapy for their gynecologic cancer. We were able to explore the impact of COVID 19 as well, as our cohorts spanned two time periods, one before the pandemic, from August 2019 to March 2020, and one that enrolled during the pandemic, from November 2020 to June of 2021.

We surveyed patients with a similar survey to prior studies, which we considered to be our financial toxicity questionnaire, and this includes demographic questions, including the comprehensive score for financial toxicity and the EQ5D for quality of life assessment. We defined financial toxicity of having a comp score less than 23. We had a response rate of over 92%, with a total of 97 participants, and approximately half of participants completed the survey pre-pandemic and half during the pandemic. We found that respondents with high levels of financial toxicity were younger and more likely to have private insurance, while race, partnership status, education, income, along with cancer type, stage, type or duration of radiation treatment, all were not associated with the degree of financial toxicity. Reduced employment for patients and their caregivers was associated with having higher financial toxicity, and we found that those with high financial toxicity were significantly and much more often concerned with the costs associated with transportation and parking.

Greater financial toxicity, as we'd shown in prior work, also correlated strongly with worse self-rated health and quality of life. And with regard to use of cost coping strategies, after adjusting for age and type of insurance, we found that participants with high financial toxicity in this study were six times more likely to report delaying or avoiding their medical care, almost 14 times as likely to need to borrow money, and nearly seven times more likely to reduce spending on basic necessities.

When we compared the pre-pandemic and during the pandemic cohorts of patients, there were actually no significant differences, which may be in part due to the small numbers of patients surveyed. However, there was an interesting trend towards less financial toxicity, and this was during the pandemic, and this was in spite of lower incomes reported during the pandemic, and higher rates of job loss and reduced income, and higher rates of applying for financial assistance.

So, in conclusion, in this cohort of gynecologic cancer patients who had recently completed radiation therapy for their diagnosis, we found that privately insured, younger patients were at higher risk for financial toxicity, which was certainly associated with worse quality of life and higher rates of reporting delayed or avoidance of medical care and need to use other economic cost coping strategies. Less financial toxicity was actually observed in the pandemic cohort, and though this was not statistically significant, it was trending towards significance and certainly more investigation is warranted to understand the impact of the COVID 19 pandemic on health care delivery in general, and its associated economic impact on patients, and how perhaps broader economic policy and access to medical care during that time may have affected the financial wellbeing of patients with cancer. In addition, future strategies to reduce financial toxicity in our patients receiving radiation treatment for gynecologic cancer should seek to address employment changes, and transportation and parking costs, in an effort to reduce this pervasive problem. Thank you.