Abstract P5-14-07: Financial toxicity in BRCA1 and BRCA2 carriers: A pilot study
Authors: Proussaloglou Ellie M , Rosenthal Alex , Raker Christina , Wilbur Jennifer Scalia , Eurich Katrin E , Stuckey Ashley , Robison Katina 
Published: March 2022

Abstract
Objective: Financial toxicity (FT), the cumulative financial burden experienced by patients due to medical care, is a well-established phenomenon. BRCA mutation carriers have increased cancer risk, require frequent screening, and often undergo prophylactic surgery, all risk factors for FT. Our primary aim in this study was to describe rates of FT among BRCA carriers. Methods: We performed a novel, cross-sectional study of FT in patients with BRCA1/2 mutations. Patients were recruited via phone and/or email; patients who agreed to participate completed consents and surveys on RedCap. The COST tool, a validated measure, was used for assessment of FT; scores were divided into tertiles, with high FT defined as COST score ≤ 24. Results: 265 BRCA positive female patients met enrollment criteria; 76 (28.7%) had responded at time of this analysis. Respondents were primarily non-Hispanic White (97.4%), privately insured (82.9%), employed full time (67.1%) with an annual income of $50,000-$99,000 (40.8%) and a mean age of 46.4 years. Fifty-nine patients (77.6%) reported undergoing prophylactic surgery related to their BRCA status. On chart review, 26 patients (34.2% of all respondents) had a confirmed prophylactic mastectomy and 44 patients (57.9%) had a confirmed bilateral salpingo-oophorectomy, with some patients undergoing both procedures. Cost concerns were widespread among respondents; 22.7% of participants reported delaying or avoiding care secondary to finances. Fifty-eight percent of patients wanted to know about the out-of-pocket costs of treatments before receiving them, but only 7.7% reported that costs were discussed. No statistically significant association was seen amongst the high FT and low/medium FT groups re: annual income, insurance type, marital status, or race. Patients with high FT were more likely to engage in all cost-saving measures, with a striking 41.7% of patients reporting delays/avoidance of care due to cost (p=0.02). High FT patients also were more likely to borrow money (16.7%, p=0.01), use savings for care (54.2%, p=0.04), and reduce spending on both necessities (37.5%, p=0.03) and leisure activities (58.3%, p=0.01). Conclusion: This study of financial toxicity in BRCA carriers shows that many patients desire information about the costs of their care and that financial toxicity is an existing issue in this unique patient population. This work serves as the first description of FT in BRCA carriers and supports efforts to incorporate routine counseling on cost in the clinical care of these high-risk patients.
Citation Format: Ellie M Proussaloglou, Alex Rosenthal, Christina Raker, Jennifer Scalia Wilbur, Katrin E Eurich, Ashley Stuckey, Katina Robison. Financial toxicity in BRCA1 and BRCA2 carriers: A pilot study [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P5-14-07.