LAUSR

BACKGROUND The cost of cancer care is high and rising. Evidence of increased patient cost burden is prevalent in the medical literature and has been defined as "financial toxicity", or the financial hardship and financial concerns experienced by patients as a result of a disease and its related treatments. With targeted therapies and growing out-of-pocket costs, patient financial toxicity is a growing concern among gynecologic cancer patients. OBJECTIVE To measure the prevalence and identify risk factors of financial toxicity for gynecologic cancer patients treated at a large cancer center using objective data. STUDY DESIGN Using institutional databases, we identified gynecologic cancer patients treated from 01/2016-12/2018. Patients with preinvasive disease were excluded. Financial toxicity was defined according to institutionally derived metrics as the presence of ≥1 of the following: ≥2 bills sent to collections, application/granting of a payment plan, settlement, bankruptcy, financial assistance program enrollment, or a finance-related social work visit. Clinical characteristics were gathered using a 2-year look-back from time of first financial toxicity event or a randomly selected treatment date for those not experiencing toxicity. Risk factors were assessed using χ2 tests. All significant variables on univariate analysis were included in the logistic regression model. RESULTS Of the 4,655 patients included in the analysis, 25% (1,155) experienced financial toxicity. In the univariate analysis, cervical cancer (35%), stage 3 or 4 disease (24% and 30%), younger age (35% for age <30 years), non-partnered marital status (31%), black (45%) or Hispanic (37%) race/ethnicity, self-pay (48%) or commercial insurance (30%), clinical trial participation (31%), more imaging studies (39% for ≥9), ≥1 emergency room visit (36%), longer inpatient stays (36% for ≥20 days), and more outpatient clinician visits (41% for ≥20 visits) were significantly associated with financial toxicity (P<0.01). In multivariate analysis, younger age, non-partnered marital status, black and Hispanic race/ethnicity, commercial insurance, more imaging studies, and more outpatient physician visits were significantly associated with financial toxicity. CONCLUSION Financial toxicity is an increasing problem for gynecologic cancer patients. Our analysis, using objective measures of financial toxicity, suggests demographic factors and healthcare utilization metrics may be used to proactively identify at-risk patients for financial toxicity.