Rural cancer financial toxicity screening

Abstract

Purpose: Cancer treatment expenses can lead to financial toxicity (FT), which reduces treatment compliance and impairs outcomes. Little is known regarding the FT among rural cancer populations, where added barriers impair accrual of survey data. To increase our understanding of FT experienced by these patients, we piloted a validated survey instrument and reported on the feasibility of administration.

Methods and materials: Institutional approval was obtained to prospectively survey rural oncology patients undergoing radiation treatment. Baseline surveys were provided at simulation appointments; weekly surveys were captured during on-treatment visits. Respondents reported on demographics (including self-reported gender, race, education, income, insurance, employment) at baseline and on expenses, the COmprehensive Score for financial Toxicity (range, 0-44, modified such that higher score indicates worse toxicity), perception of providers' financial empathy, and the minimum financially impactful amount of money at weekly visits. Completion rates and associations between demographic characteristics and FT were assessed with Mann-Whitney U test.

Results: Twenty-six participants were enrolled. Patients were elderly (mean 68.3 years old, SD 10.7), male (25 of 26), White (25 of 26). Forty-two percent were low-income (annual income < $48,000) and 50% had high school or less education. Most (n = 19, 73%) were insured through Medicare. Eighty-five percent of surveys were fully complete. The mean COmprehensive Score for financial Toxicity score at baseline was 14.0 (SD, 11.5; range, 0-38). The mean amount of money that would make a meaningful difference was $211 at baseline (interquartile range, $87.50-$350) and rose to $329 toward the end of the survey period (week 7).

Conclusions: FT screening of rural radiation oncology populations with a range of education is feasible with high fidelity of data collection. Future steps will identify patterns and predictors of severe FT and develop targeted interventions based on this feasibility study.

Figure 1

Median responses to “minimum amount of money that would make a meaningful difference to financial status.”

Figure 2

Association between income level and COST scores. Abbreviation: COST = COmprehensive Score for financial Toxicity.

Figure 3

Proportions of patients responding to “How much do you think you team understands your financial situation?”

Figure 4

Proportions of patients responding to “Which categories did you reduce expenses in?”