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Patient-reported benefit from proposed interventions to reduce financial toxicity during cancer treatment

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Abstract

Introduction

Financial toxicity is common and pervasive among cancer patients. Research suggests that gynecologic cancer patients experiencing financial toxicity are at increased risk for engaging in harmful cost-coping strategies, including delaying/skipping treatment because of costs, or forsaking basic needs to pay medical bills. However, little is known about patients’ preferences for interventions to address financial toxicity.

Methods

Cross-sectional surveys to assess financial toxicity [Comprehensive Score for Financial Toxicity (COST)], cost-coping strategies, and preferences for intervention were conducted in a gynecologic cancer clinic waiting room. Associations with cost-coping were determined using multivariate modeling. Unadjusted odds ratios (ORs) explored associations between financial toxicity and intervention preferences.

Results

Among 89 respondents, median COST score was 31.9 (IQR: 21–38); 35% (N = 30) scored < 26, indicating they were experiencing financial toxicity. Financial toxicity was significantly associated with cost-coping (adjusted OR = 3.32 95% CI: 1.08, 14.34). Intervention preferences included access to transportation vouchers (38%), understanding treatment costs up-front (35%), minimizing wait times (33%), access to free food at appointments (25%), and assistance with minimizing/eliminating insurance deductibles (23%). In unadjusted analyses, respondents experiencing financial toxicity were more likely to select transportation assistance (OR = 2.67, 95% CI: 1.04, 6.90), assistance with co-pays (OR = 9.17, 95% CI: 2.60, 32.26), and assistance with deductibles (OR = 12.20, 95% CI: 3.47, 43.48), than respondents not experiencing financial toxicity.

Conclusions

Our findings confirm the presence of financial toxicity in gynecologic cancer patients, describe how patients attempt to cope with financial hardship, and provide insight into patients’ needs for targeted interventions to mitigate the harm of financial toxicity.

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Data availability

Relevant data are available upon reasonable request.

Code availability

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Funding

This study was funded in part through the NIH/NCI Support Grant P30 CA008748.

Author information

Authors and Affiliations

  1. Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA

    Emeline M. Aviki, Kenya Braxton, Andrew J. Chi, Beryl Manning-Geist, Carol L. Brown & Nadeem R. Abu-Rustum

  2. Joan & Sanford I. Weill Medical College of Cornell University, New York, NY, USA

    Emeline M. Aviki, Carol L. Brown & Nadeem R. Abu-Rustum

  3. Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Bridgette Thom

  4. Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Fumiko Chino

  5. Immigrant Health and Cancer Disparities, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Francesca M. Gany

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  1. Emeline M. Aviki
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Contributions

EMA: study conception and design; acquisition of data; analysis and interpretation of data; drafting of article; revising article critically for important intellectual content; final approval of manuscript; accepts public responsibility for its contents. BT: study conception and design; acquisition of data; analysis and interpretation of data; drafting of article; revising article critically for important intellectual content; final approval of manuscript; accepts public responsibility for its contents. KB: acquisition of data; revising article critically for important intellectual content; final approval of manuscript; accepts public responsibility for its contents. AJC: acquisition and analysis of data; revising article critically for important intellectual content; final approval of manuscript; accepts public responsibility for its contents. BMG: analysis and interpretation of data; revising article critically for important intellectual content; final approval of manuscript; accepts public responsibility for its contents. FC: study conception and design; analysis and interpretation of data; revising article critically for important intellectual content; final approval of manuscript; accepts public responsibility for its contents. CLB: revising article critically for important intellectual content; final approval of manuscript; accepts public responsibility for its contents. NRA: study conception and design; analysis and interpretation of data; revising article critically for important intellectual content; final approval of manuscript; accepts public responsibility for its contents. FMG: study conception and design; analysis and interpretation of data; revising article critically for important intellectual content; final approval of manuscript; accepts public responsibility for its contents.

Corresponding author

Correspondence to Emeline M. Aviki.

Ethics declarations

Ethics approval

The MSKCC Institutional Review Board (IRB) determined the survey to be a quality improvement project and, as such, exempt from IRB approval.

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Not applicable.

Competing interests

BT reports the following, outside the submitted work: an Immediate family member has stock and other ownership interests in Caladrius Biosciences, Mediwound, Sierra Oncology, Lipocine, Aduro Biotech, MEI Pharma, Oncternal Therapeutics, Avadel Pharmaceuticals, Chimerix, Avidity Biosciences, Sutro Biopharma, Adma Pharma, Concert Pharmaceuticals, Process Pharmaceuticals, Curis, IMV, Arcus Biosciences, Iovance Biotherapeutics, Qiagen, Revance Therapeutics, DermTech, Zimmer BioMet, Axonics Modulation Technologies, Halozyme, Mallinckrodt, Chinook Therapeutics, OncoSec, Stemline Therapeutics. NRA reports the following, outside the submitted work: grant from Stryker/Novadaq (paid to institution); grant from Olympus (paid to institution); grant from GRAIL (paid to institution). Memorial Sloan Kettering Cancer Center (MSK) has financial interests relative to GRAIL. As a result of these interests, MSK could ultimately potentially benefit financially from the outcomes of this research.

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Bridgette Thom and Emeline M. Aviki are co-first authors.

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Aviki, E.M., Thom, B., Braxton, K. et al. Patient-reported benefit from proposed interventions to reduce financial toxicity during cancer treatment. Support Care Cancer 30, 2713–2721 (2022). https://doi.org/10.1007/s00520-021-06697-6

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