Financial toxicity and employment outcomes in people with melanoma receiving adjuvant therapies.

Abstract

9577 Background: One year ofadjuvant anti-programmed cell death protein-1 (anti-PD1) or dabrafenib-trametinib are standards of care for patients (pts) with resected stage III-IV melanoma. The impact of adjuvant therapy on a pt’s employment, income, and level of financial toxicity are unknown. We examined these outcomes up to 2 years post initiation of adjuvant therapy. Methods: A prospective, longitudinal study of pts with resected stage IIB-IV melanoma receiving adjuvant anti-PD1 or dabrafenib-trametinib at an Australian comprehensive cancer center. Two customized employment surveys assessed impact on employment and income. Survey 1 (7 items) was administered pre-treatment, Survey 2 (11 items) at 12 and 24 months post treatment initiation. The Comprehensive Score for Financial Toxicity (FACIT-COST) was collected pre-treatment and at 1, 3, 6, 12, and 24 months post treatment initiation. FACIT-COST scores were categorized into none (≥26), mild (14-25), moderate (1-13) and severe (0) financial toxicity. Results: Between September 2021-December 2024, 70 pts were eligible and 52 (74%) consented: 17 (33%) female, median age 64 years (IQR 60-71), 46 (89%) had resected stage III, 32 (62%) on adjuvant anti-PD1. 41 pts had completed treatment and 11 were still receiving treatment at data cut off (17 December 2024). Employment surveys were completed by 51 pts pre-treatment, 31 at 12 months and 18 at 24 months. Most (18/31, 58%) were working at 12 months, with the majority (17/18, 94%) in the same job as pre-treatment. Only half (9, 50%) were working the same number of hours or earning the same income (10, 56%) as pre-treatment (the remainder, less). Barriers to returning to work at 12 months were ongoing symptoms (45%), financial concerns (26%), and work environment (21%). 18 pts completed both the 12 and 24 month surveys. 9 (50%) had returned to work by 12 months and the majority (n=8) were still working at 24 months. At 24 months, 6 (75%) were working the same number of hours but only 5 (63%) were earning the same income as pre-treatment (the remainder, less). The prevalence of financial toxicity is shown in the table and ranged from 16% at 6 months to 36% at 12 months. Conclusions: Half of pts reported reduced working hours and income 12 months post therapy initiation, mostly due to ongoing symptoms. A third reported financial toxicity at 12 months, even with universal healthcare. This data can inform shared decision-making about risks and benefits of adjuvant therapy and highlights the importance of screening for financial toxicity to identify pts who require support. FACIT-COST category Pre-treatment (n= 51) 1 month (n=46) 3 months (n=44) 6 months (n=38) 12 months (n=31) 24 months (n=18) None 37 (72.5) 32 (69.6) 35 (79.5) 32 (84.2) 20 (64.5) 13 (72.2) Mild 13 (25.5) 11 (23.9) 6 (13.6) 5 (13.2) 10 (32.3) 2 (11.1) Moderate 1 (2.0) 2 (4.3) 3 (6.8) 1 (2.6) 1 (3.2) 3 (16.7) Severe 0 1 (2.2) 0 0 0 0 Any 14 (27.5) 14 (30.4) 9 (20.5) 6 (15.8) 11 (35.5) 5 (27.8)