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Original research
Evaluating meaningful levels of financial toxicity in gynecologic cancers
  1. Katharine McKinley Esselen1,2,
  2. Annika Gompers1,
  3. Michele R Hacker1,2,
  4. Sara Bouberhan3,
  5. Meghan Shea4,
  6. Sarah S Summerlin5,
  7. Lindsay R Rucker6,
  8. Warner K Huh6,
  9. Maria Pisu7 and
  10. Margaret I Liang6
  1. 1Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
  2. 2Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, Massachusetts, USA
  3. 3Department of Hematology/Medical Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA
  4. 4Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
  5. 5School of Medicine, The University of Alabama, Birmingham, Alabama, USA
  6. 6Department of Obstetrics and Gynecology, The University of Alabama, Birmingham, Alabama, USA
  7. 7Department of Internal Medicine, The University of Alabama, Birmingham, Alabama, USA
  1. Correspondence to Dr Katharine McKinley Esselen, Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA; kesselen{at}bidmc.harvard.edu

Abstract

Objective The Comprehensive Score for Financial Toxicity (COST) is a validated instrument measuring the economic burden experienced by patients with cancer. We evaluated the frequency of financial toxicity at different COST levels and stratified risk factors and associations with cost-coping strategies by financial toxicity severity.

Methods We analyzed previously collected survey data of gynecologic oncology patients from two tertiary care institutions. Both surveys included the COST tool and questions assessing economic and behavioral cost-coping strategies. We adapted a proposed grading scale to define three groups: no/mild, moderate, and severe financial toxicity and used χ2, Fisher’s exact test, and Wilcoxon rank sum test to compare groups. We used Poisson regression to calculate crude and adjusted risk ratios for cost-coping strategies, comparing patients with moderate or severe to no/mild financial toxicity.

Results Among 308 patients, 14.9% had severe, 32.1% had moderate, and 52.9% had no/mild financial toxicity. Younger age, non-white race, lower education, unemployment, lower income, use of systemic therapy, and shorter time since diagnosis were associated with worse financial toxicity (all p<0.05). Respondents with moderate or severe financial toxicity were significantly more likely to use economic cost-coping strategies such as changing spending habits (adjusted risk ratio (aRR) 2.7, 95% CI 1.8 to 4.0 moderate; aRR 3.6, 95% CI 2.4 to 5.4 severe) and borrowing money (aRR 5.5, 95% CI 1.8 to 16.5 moderate; aRR 12.7, 95% CI 4.3 to 37.1 severe). Those with severe financial toxicity also had a significantly higher risk of behavioral cost-coping through medication non-compliance (aRR 4.6, 95% CI 1.2 to 18.1).

Conclusions Among a geographically diverse cohort of gynecologic oncology patients, nearly half reported financial toxicity (COST <26), which was associated with economic cost-coping strategies. In those 14.9% of patients reporting severe financial toxicity (COST <14) there was also an increased risk of medication non-compliance, which may lead to worse health outcomes in this group.

  • surgical oncology

Data availability statement

Data are available upon reasonable request and with appropriate institutional review board approval.

https://doi.org/10.1136/ijgc-2021-002475

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    Data availability statement

    Data are available upon reasonable request and with appropriate institutional review board approval.

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    Footnotes

    • Contributors KME: conceptualization, investigation, methodology, supervision, writing – original draft preparation. AG: formal analysis, writing – reviewing and editing. MRH: conceptualization, methodology, supervision, writing – reviewing and editing. SB: investigation, writing – reviewing and editing. MS: writing – reviewing and editing. SSS: investigation, writing – reviewing and editing. LRR: investigation, writing – reviewing and editing. WKH: writing – reviewing and editing. MP: methodology, supervision, writing – reviewing and editing. MIL: conceptualization, investigation, methodology, supervision, writing – original draft preparation.

    • Funding MIL was supported by a National Institute of Child and Human Development Women’s Reproductive Health Research Career Development K-12 Grant (5K12HD001258) for this work. The Retention and Recruitment Shared Facility at O’Neal Comprehensive Cancer Center used to conduct the surveys at University of Alabama at Birmingham is supported by the Cancer Center Support Grant (P30CA013148). KME was supported by the Eleanor and Miles Shore 50th Anniversary Fellowship Program and Harvard Catalyst | The Harvard Clinical and Translational Science Center (National Center for Advancing Translational Sciences, National Institutes of Health Award UL 1TR002541) and financial contributions from Harvard University and its affiliated academic healthcare centers. The funding organizations had no role in the preparation, review, or approval of the manuscript.

    • Competing interests WKH reports personal fees from LICOR Biosciences, Altum outside the submitted work and serves on the Data and Safety Monitoring board for Inovio Pharmaceuticals.

    • Provenance and peer review Not commissioned; externally peer reviewed.

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