Abstract P6-05-29: Experience of Financial Toxicity and Distress Among Individuals Diagnosed with Triple Negative Breast Cancer: Findings from the Cancer Experience Registry
Authors: Doughtie Kara , Fortune Erica E. , Badt Heather , Lawrence Caroline , Popalis Madyson L. , Miller Melissa F. 
Published: March 2023

Abstract
Background: Financial toxicity associated with cancer and its treatment can negatively impact treatment adherence and quality of life. Individuals with triple negative breast cancer (TNBC) may be at increased risk for financial toxicity due to the aggressive nature of the disease and high rate of recurrence. The objective of this study was to characterize financial experiences of TNBC survivors, their descriptions of communication with providers concerning treatment costs, and correlations between financial toxicity and psychosocial distress. Methods: From July 2017 to August 2021, 94 individuals with TNBC took part in Cancer Support Community’s Cancer Experience Registry® (CER). Participants completed items related to financial distress, including COmprehensive Score for Financial Toxicity (COST), an 11-item (0=Not at all, 4=Very much) measure of financial well-being (range 0-44; lower scores indicate worse financial well-being), dichotomous (yes or no) items assessing patient-provider communication, and Patient-Reported Outcomes Measurement Information System-29 (PROMIS-29 v2.0). Bivariate relations were assessed using Pearson’s correlation. Results: Participants were 81% non-Hispanic White, 6% Black, and 6% Hispanic. Mean age was 52 years (SD=11.3); 14 (15%) reported household income &lt;$40K. Median time since diagnosis was 2 years; 15% (n=14) reported metastatic breast cancer and 36% were currently receiving treatment. Concerning out-of-pocket cancer-related costs, 56% of our sample reported spending &gt;$250 per month; 32% &gt;$500; 13% &gt;$1000. To reduce costs, 23% sometimes, often, or always postponed seeking psychological support, 19% delayed follow-up on recommendations, 6% postponed doctor’s appointments, and 5% skipped medication. The mean COST score was 23.0 (SD=12.3), indicating mild financial distress overall. Less than half of the sample (46%) indicated no financial toxicity (scores &gt;25), 29% mild financial toxicity (scores 14-25), 22% moderate (score 1-13), and 3% severe (score of 0). The frequency of individual COST items showed 61% reported (somewhat, quite a bit, or very much) worry about future financial problems due to treatment costs; 14% were unable to meet monthly expenses; 49% reported concern about keeping their job or income; 47% reported frustration that they could not work or contribute as usual. COST scores were inversely correlated to PROMIS anxiety (r=-.45, p&lt;.001), depression (r=-.44, p&lt;.001), and sleep disturbance subscales (r=-.48, p&lt;.001), such that lower financial well-being related to more symptomology. COST scores were positively associated with the social function subscale (r=.46, p&lt;.001), so that better financial well-being related to higher social functioning. Regarding patient-provider communication, 70% reported their health care team did not discuss costs, 62% did not discuss impact of TNBC and treatment on work, and 59% did not discuss financial concerns. One-third (34%) wished they received more financial advice and assistance. Conclusion: In this sample of TNBC patients, average levels of financial toxicity were in the mild range. However, many reported moderate to severe toxicity (25%). Greater financial toxicity related to increased symptoms of anxiety, depression, sleep disturbance, and worse social functioning. Despite this, results indicate there is little patient-provider discussion about financial burden, with more than half of our sample reporting their health care team did not discuss costs, impact on work, or financial distress. One-third of participants indicated desire for more financial advice and assistance highlighting an opportunity to better serve TNBC patients, who may be at an increased risk of financial toxicity.
Citation Format: Kara Doughtie, Erica E. Fortune, Heather Badt, Caroline Lawrence, Madyson L. Popalis, Melissa F. Miller. Experience of Financial Toxicity and Distress Among Individuals Diagnosed with Triple Negative Breast Cancer: Findings from the Cancer Experience Registry [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P6-05-29.