Financial toxicity and unmet essential needs in patients with gastrointestinal cancer.
Authors: Kaitlyn Lapen, Edward Christopher Christopher Dee, Bridgette Thom, Emeline Mariam Aviki, Fumiko Chino
Journal: Journal of Clinical Oncology (2024)

3527 Background: Patients with gastrointestinal (GI) cancers face complex, multimodality treatment and often experience financial toxicity (FT), which can negatively affect both psychosocial and oncologic outcomes. Despite increased recognition of the role of the social determinants of health in driving cancer disparities, best practices in screening for FT and assessment of unmet essential needs in this population is still unknown. Methods: From 6/2022-8/2023, cross-sectional FT assessments were conducted at a comprehensive cancer center for all patients with gastrointestinal cancers. The Comprehensive Score for Financial Toxicity (COST) assessed FT; ability to meet essential needs, financial concerns, and quality of life (QOL) were also queried. Multivariate linear and logistic regression tested for predictors of FT and unmet needs and were adjusted for patient and clinical characteristics. Results: There were 8,335 patients with GI cancers who completed the FT and essential needs assessment. Mean age was 63.0 years (SD 12.6) and 76% were non-Hispanic white (NHW). GI subsites were most commonly colon (29%), rectum (21%), and pancreas (18%). 54% had active cancer treatment (chemotherapy, radiation, or surgery) within 120 days of assessment. Mean COST score was 24.3 (SD 10.7; scale 0-44, lower scores indicate worse FT). 63% had COST &lt;26 diagnostic of FT. Regression analysis found greater FT was associated with non-NHW race/ethnicity (β 4.43, P&lt;0.001), advanced disease [stage III (β 1.34, P&lt;0.001), stage IV (β 1.68, P&lt;0.001)], and recent treatment (β 3.23, P&lt;0.001). Patients ≥65 years had lower FT (β -3.67, p&lt;0.001). 28% reported difficulty meeting an essential need including paying for transportation (12%), housing (12%), food (11%), and medications (11%). Regression analysis found unmet needs were associated with non-NHW race/ethnicity (OR 2.34, 95% CI 2.09-2.62, p&lt;0.001), advanced disease [stage III (OR 1.28, 95% CI 1.09-1.49, p=0.002), stage IV (OR 1.27, 95% CI 1.08-1.49, p=0.003)] and recent treatment (OR 1.25, 95% CI 1.12-1.39, p&lt;0.001). FT and unmet needs did not vary significantly by disease subsite. 26% reported using savings to pay for cancer treatment; an additional 7% had no savings to begin with. 10% took less medications than prescribed due to cost. Mean QOL score was 7.2 [(SD 2.0) 0 “as bad as it can be” to 10 “as good as it can be”]. Regression analyses found greater FT was associated with lower QOL (β -0.98, p&lt;0.001), increased amount of savings to pay for treatment (β 0.48, p&lt;0.001), and taking less medications than prescribed due to cost (β 0.11, p&lt;0.001). Conclusions: Screening for FT and essential needs is possible in a diverse cohort of patients with GI cancers. Over half were identified to have FT and over one fourth had unmet essential needs. Identifying and addressing the financial burdens of cancer treatment and essential needs may improve QOL, medication adherence, and cancer survivorship.