Financial toxicity identified by COST–FACIT screening in a community oncology population: A retrospective study.

Abstract

e23103 Background: Financial toxicity (FT) is common among patients receiving cancer treatment and is associated with adverse clinical and quality of life outcomes. Patients undergoing active cancer therapy at a community hospital who screened positive for FT and met income-based criteria were eligible for financial assistance through an institutional support program. We conducted a retrospective analysis to evaluate demographic, socioeconomic, and clinical factors associated with FT. Methods: We performed a retrospective chart review of 426 adult patients with stage I-IV cancer receiving IV, injectable, or oral systemic therapies dispensed through a specialty pharmacy who completed the COST–FACIT questionnaire. Data collected: demographics, marital and employment status, insurance coverage, tumor characteristics and treatment. Data were de-identified and managed using REDCap. Analyses are descriptive. Results: Median age at first FACIT completion: 68 yrs (range, 30–100). Gender identity: cisgender female in 304 (71.4%), cisgender male in 121 (28.4%), and other in 1 (0.2%). Race and ethnicity: self-reported as white (77.6%), Hispanic or Latino (8.7%), Black or African American (5.6%), Asian (4.9%), and other (3.1%). 59.6% patients were married, with 40.6% employed and 39.4% retired. Insurance coverage included Medicare (n = 163), private/commercial insurance (n = 162), Medicare Advantage (n = 89), uninsured (n = 11), and other (n = 1). Tumor types: breast/gyn (50.7%), gastrointestinal (GI) (17.6%), hematologic (11.7%), thoracic (9.2%), genitourinary (GU) (4.0%) and other (6.8%). At time of first FACIT assessment, patients were receiving IV (56.8%), oral (21.3%), injectable (2.3%), or combination systemic therapy involving more than one treatment modality (19.5%). Mean FACIT score: 22.95 (SD 11.22). Individuals with FACIT scores < 26 were considered to meet criteria for clinically significant FT. 236 (55%) individuals met criteria for FT and were referred to a financial advocate. Tumor types in FT cohort: breast/gyn (46.2%), hematologic (16.9%), GI (14.8%), thoracic (10.2%), GU (3.8%) and other (8%). Treatment modalities in FT cohort: IV (51.6%), oral (21.2%), combination (24.1%), and injectable therapy (3%). Differences in tumor type and treatment modality distributions were observed between the overall and FT cohorts. Conclusions: Clinically significant FT was highly prevalent among patients receiving active cancer treatment, even within a high socioeconomic status region. Differences observed between the overall and FT cohorts underscore the heterogeneity in financial burden across tumor types and treatment modalities. These descriptive findings support routine FT screening and early referral to financial advocacy services. Additional analyses are ongoing and will further evaluate demographic, socioeconomic, and clinical contributors to FT.