Assessing the impact of financial toxicity among cancer patients on immunotherapy and targeted therapy: Insights from a tertiary cancer centre in south India.

Abstract

e13530 Background: Cancer is currently the second leading cause of death globally – a burden disproportionately borne by low- and middle-income countries, amounting to 70% of cancer deaths. According to 2020 WHO report, India reported only two-thirds of new cancer cases compared to the USA, yet the number of deaths was 30% higher. This is primarily due to poor economic status leading to limited access to healthcare facilities. Financial burden from cancer care results not only from treatment related expenses, but can also be attributed to travelling, food expenditure, physiotherapy and caregiver expenses. Although health insurance schemes and patient assistance programmes (PAP) have helped to mitigate treatment costs, financial toxicity (FT) specially in the setting of immunotherapy and targeted therapy is a huge barrier to optimal cancer care . It can lead to poor quality of life, delaying or discontinuation of treatment, emotional distress and ultimately poor survival. Methods: Observational study conducted in Apollo Hospitals, Bangalore. 72 patients aged > 18 years, receiving immunotherapy or targeted therapy (intravenous or oral) for atleast 2 months at the time of interview were included. Data related to age, sex, education, monthly income, type of insurance and enrolment in patient assistance programmes (PAP) were collected. FT was determined by the Comprehensive Score for financial Toxicity (COST)‐Functional Assessment of Chronic Illness Therapy (FACIT). Results: 72 patients with different cancers, majority being breast (35%) and lung (18%) were included. 65% had metastatic and 35% had locally advanced cancers. 49% received immunotherapy and 51% received targeted therapy. 80% (n-58) patients had availed insurance benefits, but only 21% felt the coverage was sufficient. 62% (n-45) patients had been enrolled for PAP which helped to obtain both IV and oral medications at subsidised rates. The median COST FACIT score was 14.2 with scores > 26 graded as mild FT and < 13 as severe FT. Higher income levels (> 6000 US dollars per month) were significantly associated with lesser FT (p value-0.029). Presence of PAP correlated with lower FT although not statistically significant (p value-0.08). Patients requiring IV immunotherapy and targeted therapy faced more FT due to repeated admissions (median admissions > 3) (p value-o.o5). Significant out of pocket expenditure leading to FT was attributed to travelling (p value-0.016) and food (p value-0.009). Treatment discontinuation was observed in 11% (n-8) patients. Conclusions: Financial toxicity is a major hinderance for availing expensive modalities of cancer therapies. FT was majorly determined by the patient’s economical status irrespective of cancer stage, type of treatment, insurance or PAP. Better access to PAPs has reduced treatment discontinuations, but they have so far been unsuccessful in effectively reducing financial toxicity.