Synapse - Risk factors for financial toxicity in patients with gynecologic cancer

Risk factors for financial toxicity in patients with gynecologic cancer Journal Article

Authors:	Aviki, E. M.; Manning-Geist, B. L.; Sokolowski, S. S.; Newman, T.; Blinder, V. S.; Chino, F.; Doyle, S. M.; Liebhaber, A.; Gordhandas, S. B.; Brown, C. L.; Broach, V.; Chi, D. S.; Jewell, E. L.; Leitao, M. M. Jr; Long Roche, K.; Mueller, J. J.; Sonoda, Y.; Zivanovic, O.; Gardner, G. J.; Abu-Rustum, N. R.
Article Title:	Risk factors for financial toxicity in patients with gynecologic cancer
Abstract:	Background: The cost of cancer care is high and rising. Evidence of increased patient cost burden is prevalent in the medical literature and has been defined as “financial toxicity,” the financial hardship and financial concerns experienced by patients because of a disease and its related treatments. With targeted therapies and growing out-of-pocket costs, patient financial toxicity is a growing concern among patients with gynecologic cancer. Objective: This study aimed to determine the prevalence of financial toxicity and identify its risk factors in patients with gynecologic cancer treated at a large cancer center using objective data. Study Design: Using institutional databases, we identified patients with gynecologic cancer treated from January 2016 to December 2018. Patients with a preinvasive disease were excluded. Financial toxicity was defined according to institutionally derived metrics as the presence of ≥1 of the following: ≥2 bills sent to collections, application or granting of a payment plan, settlement, bankruptcy, financial assistance program enrollment, or a finance-related social work visit. Clinical characteristics were gathered using a 2-year look-back from the time of the first financial toxicity event or a randomly selected treatment date for those not experiencing toxicity. Risk factors were assessed using chi-squared tests. All significant variables on univariate analysis were included in the logistic regression model. Results: Of the 4655 patients included in the analysis, 1155 (25%) experienced financial toxicity. In the univariate analysis, cervical cancer (35%), stage 3 or 4 disease (24% and 30%, respectively), younger age (35% for age <30 years), nonpartnered marital status (31%), Black (45%) or Hispanic (37%) race and ethnicity, self-pay (48%) or commercial insurance (30%), clinical trial participation (31%), more imaging studies (39% for ≥9), ≥1 emergency department visit (36%), longer inpatient stays (36% for ≥20 days), and more outpatient clinician visits (41% for ≥20 visits) were significantly associated with financial toxicity (P<.01). In multivariate analysis, younger age, nonpartnered marital status, Black and Hispanic race and ethnicity, commercial insurance, more imaging studies, and more outpatient physician visits were significantly associated with financial toxicity. Conclusion: Financial toxicity is an increasing problem for patients with gynecologic cancer. Our analysis, using objective measures of financial toxicity, has suggested that demographic factors and healthcare utilization metrics may be used to proactively identify at-risk patients for financial toxicity. © 2021 Elsevier Inc.
Keywords:	adult; risk factors; risk factor; genital neoplasms, female; health care cost; health expenditures; patient attitude; gynecologic cancer; risk analysis; patient acceptance of health care; female genital tract tumor; humans; human; female; financial toxicity; financial stress
Journal Title:	American Journal of Obstetrics and Gynecology
Volume:	226
Issue:	6
ISSN:	0002-9378
Publisher:	Elsevier Inc.
Date Published:	2022-06-01
Start Page:	817.e1
End Page:	817.e9
Language:	English
DOI:	10.1016/j.ajog.2021.12.012
PUBMED:	34902319
PROVIDER:	scopus
PMCID:	PMC9512155
DOI/URL:	https://www.scopus.com/inward/record.uri?eid=2-s2.0-85123320656&doi=10.1016%2fj.ajog.2021.12.012&partnerID=40&md5=e75a85b62ca2682cc8462f6fd10ff3ea
Notes:	Article -- Export Date: 1 July 2022 -- Source: Scopus