Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Jul;154(1):8-12.
doi: 10.1016/j.ygyno.2019.04.003. Epub 2019 Apr 30.

Financial toxicity in gynecologic oncology

Sara Bouberhan  1 , Meghan Shea  1 , Alice Kennedy  2 , Adrienne Erlinger  2 , Hannah Stack-Dunnbier  2 , Mary K Buss  1 , Laureen Moss  3 , Kathleen Nolan  2 , Christopher Awtrey  4 , John L Dalrymple  4 , Leslie Garrett  4 , Fong W Liu  4 , Michele R Hacker  5 , Katharine M Esselen  6
Affiliations

Financial toxicity in gynecologic oncology

Sara Bouberhan et al. Gynecol Oncol. 2019 Jul.

Abstract

Objectives: Financial toxicity is increasingly recognized as an adverse outcome of cancer treatment. Our objective was to measure financial toxicity among gynecologic oncology patients and its association with demographic and disease-related characteristics; self-reported overall health; and cost-coping strategies.

Methods: Follow-up patients at a gynecologic oncology practice completed a survey including the COmprehensive Score for Financial Toxicity (COST) tool and a self-reported overall health assessment, the EQ-VAS. We abstracted disease and treatment characteristics from medical records. We dichotomized COST scores into low and high financial toxicity and assessed the correlation (r) between COST scores and self-reported health. We calculated risk ratios (RR) and 95% confidence intervals (CI) for the associations of demographic and disease-related characteristics with high financial toxicity, as well as the associations between high financial toxicity and cost-coping strategies.

Results: Among 240 respondents, median COST score was 29. Greater financial toxicity was correlated with worse self-reported health (r = 0.47; p < 0.001). In the crude analysis, Black or Hispanic race/ethnicity, government-sponsored health insurance, lower income, unemployment, cervical cancer and treatment with chemotherapy were associated with high financial toxicity. In the multivariable analysis, only government-sponsored health insurance, lower income, and treatment with chemotherapy were significantly associated with high financial toxicity. High financial toxicity was significantly associated with all cost-coping strategies, including delaying or avoiding care (RR: 7.3; 95% CI: 2.8-19.1).

Conclusions: Among highly-insured gynecologic oncology patients, many respondents reported high levels of financial toxicity. High financial toxicity was significantly associated with worse self-reported overall health and cost-coping strategies, including delaying or avoiding care.

Keywords: Costs of cancer care; Financial burden; Financial toxicity; Gynecology oncology patients; Patient reported outcomes.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest

The following authors have confirmed that there are no potential conflicts of interest or disclosures to report pertaining to this submission: Sara Bouberhan, Meghan Shea, Alice Kennedy, Adrienne Erlinger, Hannah Stack-Dunnbier, Mary K. Buss, Laureen Moss, Kathleen Nolan, Christopher Awtrey, John L. Dalrymple, Leslie Garrett, Fong W Liu, Michele R Hacker, Katharine M Esselen

Figures

Figure 1:
Figure 1:. Risk of Using Cost-Coping Strategies among Respondents with High Financial Toxicity Compared to Respondents with Low Financial Toxicity
Plotted on the x-axis are the risk ratio and 95% confidence interval for the risk of each cost-coping strategy among respondents with high financial toxicity compared to low financial toxicity.
See this image and copyright information in PMC

Comment in

References

    1. de Souza JA, et al., The development of a financial toxicity patient-reported outcome in cancer: The COST measure. Cancer, 2014. 120(20): p. 3245–53. - PubMed
    1. de Souza JA, et al., Measuring financial toxicity as a clinically relevant patient-reported outcome: The validation of the COmprehensive Score for financial Toxicity (COST). Cancer, 2017. 123(3): p. 476–484. - PMC - PubMed
    1. Ramsey S, et al., Washington State cancer patients found to be at greater risk for bankruptcy than people without a cancer diagnosis. Health Aff (Millwood), 2013. 32(6): p. 1143–52. - PMC - PubMed
    1. Ramsey SD, et al., Financial Insolvency as a Risk Factor for Early Mortality Among Patients With Cancer. J Clin Oncol, 2016. 34(9): p. 980–6. - PMC - PubMed
    1. Zafar SY, et al., Population-based assessment of cancer survivors’ financial burden and quality of life: a prospective cohort study. J Oncol Pract, 2015. 11(2): p. 145–50. - PMC - PubMed

Publication types

MeSH terms