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Original research
Financial toxicity in gynecologic oncology: a multi-practice survey
  1. Anna Jo Smith1,2,3,4,
  2. Maya H Sharma5,
  3. Kristina Powell1,2,
  4. Meredith Doherty3,4,6,
  5. Stefanie N Hinkle1,7 and
  6. Emily Meichun Ko1,2,3,4
    1. 1Department of Obstetrics and Gynecology, University of Pennsylvania Health Systems, Philadelphia, Pennsylvania, USA
    2. 2Division of Gynecologic Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
    3. 3Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
    4. 4Penn Center for Cancer Care Innovation, University of Pennsylvania, Philadelphia, Pennsylvania, USA
    5. 5University of Pennsylvania, Philadelphia, Philadelphia, USA
    6. 6School of Social Policy and Practice, University of Pennsylvania, Philadelphia, Pennsylvania, USA
    7. 7Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
    1. Correspondence to Dr Anna Jo Smith, Department of Obstetrics and Gynecology, University of Pennsylvania Health Systems, Philadelphia, USA; annajo.smith{at}pennmedicine.upenn.edu

    Abstract

    Background Financial toxicity is associated with worse cancer outcomes, including lower survival.

    Objective To characterize the prevalence of, and patient risk factors for, financial toxicity among gynecologic oncology patients in a multi-site health system.

    Methods We identified patients seen in University of Pennsylvania gynecologic oncology practices between January 2020 and February 2022 with a patient portal account. We sent a survey to all alive patients twice between March and April 2022, including the 11-item Comprehensive Score for Financial Toxicity (COST) tool. We compared differences between patients reporting high (COST score <26) and low financial toxicity (COST score ≥26) in Χ2 and regression analyses.

    Results Of 8239 patients, 6925 had a portal account, and 498 completed the survey for 7.2% response rate. 44% had a COST score <26, indicating financial toxicity. Patients with high financial toxicity were more likely to be younger (mean age 54 vs 60), have cervical cancer (10% vs 4%; p=0.008), be privately insured (71% vs 57%; p=0.003) or have Medicaid (7% vs 3%; p=0.03), or be unemployed (18% vs 3%; p=<0.001), and less likely to be white (79% vs 90%, p=0.003) than those with low financial toxicity. Patients with Medicare were less likely to experience financial toxicity than privately insured patients (RR=0.59, 95% CI 0.37 to 0.95).

    Conclusion In this study of patients with gynecologic cancer or pre-cancer, 44% had financial toxicity. Financial toxicity was higher in patients who were younger, did not identify as White, and had private insurance. Targeted measures to address financial toxicity are needed to minimize disparities in patient burden of cancer treatment.

    • Cervical Cancer
    • Ovarian Cancer
    • Quality of Life (PRO)/Palliative Care
    • Uterine Cancer

    Data availability statement

    Data are available upon reasonable request. We can provide data de-identified to other researchers on request.

    https://doi.org/10.1136/ijgc-2023-005054

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      Data availability statement

      Data are available upon reasonable request. We can provide data de-identified to other researchers on request.

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      Footnotes

      • Contributors AJS conceptualized and led the study. KP assisted with survey administration and analysis. MS assisted with data analysis and manuscript preparation. SH, MD, and EMK assisted with data analysis and critically reviewed the manuscript as submitted. AJS accepts full responsibility for the work and/or the conduct of the study, had access to the data, and controlled the decision to publish.

      • Funding Drs. Smith and Ko received support from the Foundation for Women‘s Cancer Diversity and Inclusion Health Equity Research Grant. A previous version of this work was presented as a poster at the Society for Gynecologic Oncology annual meeting in March 2023. Dr. Smith has received grant funding from GSK and an award from Eisai, Inc. unrelated to this research.

      • Competing interests The authors have disclosed no financial relationships relevant to this article. AJS has received grant funding from GSK and an award from Eisai, Inc. unrelated to this research.

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

      • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.