Abstract 4827: Financial toxicity among cancer survivors during the COVID-19 pandemic
Authors: Srivastava Tanvi , Shariff-Marco Salma , Washington Samuel L. , Miaskowski Christine , Chan June M. 
Published: March 2024

Abstract
Background: Financial toxicity (FT), the financial impact of cancer and its treatments on patients’ employment, income, and health insurance, can have significant short- and long-term consequences for cancer survivors. With significant increases in cancer survivorship and the changing demographics of the United States, a need exists to identify those most susceptible to FT. This study evaluated FT prevalence during the COVID-19 pandemic and identified factors associated with greater FT risk.
Methods: Data were collected from 1,147 cancer survivors recruited from previous National Cancer Institute-funded studies, from electronic health record searches for patients with cancer diagnoses at University of California, San Francisco (UCSF) and Mount Sinai Medical Center and Columbia University Medical Center in New York City, and the Dr. Susan Love Foundation for Breast Cancer Research. Adults, diagnosed with cancer and proficient in English, completed an online survey via the Research Electronic Data Capture (REDCap) system between May 27, 2020 and February 21, 2021. FT was assessed for the past 14 days using the validated 11-item COmprehensive Score for financial Toxicity (COST) measure. Patients were categorized by score: no FT (COST scores &gt;25), mild FT (14-25), and moderate/severe FT (0-13). Using Pearson’s chi-square test of independence, and univariate ordinal logistic regression, the study evaluated sociodemographic and clinical characteristics associated with FT, including age, race and ethnicity, gender, household income, education, marital status, health insurance status, and cancer site.
Results: The COST measure had excellent reliability for the sample (Cronbach’s alpha = 0.911). Overall, 9% of respondents reported moderate/severe FT (MSFT), 16% mild. Race/ethnicity, education level, annual household income, cancer site, and years from diagnosis (p-values ≤ 0.035) were associated with FT. Current health insurance coverage was not associated with FT (p=0.456). 18% Black, 13% Asian American, 17% mixed, and 20% other races/ethnicities reported MSFT, while 8% non-Hispanic White and 5% Hispanic respondents reported the same. 31% of survivors with annual household income &lt;$40,000 reported MSFT vs. 7% with ≥$40,000 income. 14% of survivors with less than a college degree reported MSFT vs. 8% amongst those with a college degree or higher. For men, the odds of having FT (mild or MSFT) were 0.60 (95% CI 0.40, 0.90) times that of women. Survivors &lt;50 years old at diagnosis had 7.53 (95% CI 4.09, 13.83) times the odds of FT (mild or MSFT) vs. those aged ≥75 years.
Conclusions: These preliminary analyses from this cross-sectional study characterizes the prevalence and determinants of FT experienced by cancer survivors during the COVID-19 pandemic. The next steps will include multivariable analysis and comparison with pre-pandemic data, to identify those at greatest risk and inform interventions.
Citation Format: Tanvi Srivastava, Salma Shariff-Marco, Samuel L. Washington, Christine Miaskowski, June M. Chan. Financial toxicity among cancer survivors during the COVID-19 pandemic [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 4827.