In a new study designed to provide a more comprehensive picture of how a diverse cohort of patients with gynecologic cancer are affected by financial distress, nearly half reported financial toxicity, which was associated with economic cost-coping strategies. These findings were reported by Esselen et al in the International Journal of Gynecological Cancer.

“To broaden our understanding of financial toxicity in gynecologic oncology, we combined data from our two very geographically distinct institutions—Beth Israel Deaconess Medical Center in Boston and the University of Alabama at Birmingham—to create a diverse cohort of patients,” said corresponding study author Katharine M. Esselen, MD, MBA, a physician-researcher in the Division of Gynecologic Oncology in the Department of Obstetrics and Gynecology at Beth Israel Deaconess Medical Center. "Yet despite the many differences in the demographic characteristics of the surveyed patients at each institution—including important risk factors for financial toxicity, such as race, income, education, employment status, and insurance status—patients had a similar risk of financial toxicity.”

COST Analysis

Using the Comprehensive Score for Financial Toxicity (COST) to measure the economic burden experienced by patients with cancer, Dr. Esselen and colleagues analyzed previously collected survey data from 308 patients with gynecologic cancer—240 patients surveyed at Beth Israel Deaconess and 121 surveyed at the University of Alabama. The team adapted a proposed grading scale to define three groups—no/mild, moderate, and severe financial toxicity—and evaluated the frequency of financial toxicity among each group.

Results

Nearly half of patients with gynecologic cancer reported experiencing moderate to severe financial toxicity. Further analysis of survey data revealed that younger patients were at greater risk of experiencing financial toxicity, for a variety of reasons: younger patients are not eligible for Medicare, and diagnosis and treatment may impact their ability to work. They have also had fewer earning years to accumulate a financial safety net.

Patients reporting severe financial toxicity accounted for 15% of those surveyed. Dr. Esselen and colleagues found that this group was more likely to report changing spending habits and borrowing money due to the costs of cancer care. Most alarmingly, those reporting severe financial hardship were nearly five times more likely to attempt to cope with the high cost of care through medication noncompliance.

“Our study confirms that financial toxicity is a very common problem among patients with gynecologic cancers and that there are increasingly worrisome cost-coping strategies employed with increasing severity of the financial toxicity, including medication nonadherence as a cost-coping strategy,” said Dr. Esselen. “As this is a relatively new area of investigation, we need to continue to identify patient and disease characteristics that most contribute to the development of financial toxicity. Further, we need to identify which risk factors are potentially modifiable and begin to design and test interventions to learn how we can better treat financial toxicity.”

Disclosure: This work was supported in part by the National Institute of Child and Human Development, the Retention and Recruitment Shared Facility at O’Neal Comprehensive Cancer Center, the National Center for Advancing Translational Sciences, National Institutes of Health, Harvard University and its affiliated academic health-care centers, and the Eleanor and Miles Shore 50th Anniversary Fellowship Program. For full disclosures of the study authors, visit ijgc.bmj.com.