Predictors of Financial Toxicity in Patients Receiving Concurrent Radiation Therapy and Chemotherapy

• DOI: 10.1016/j.adro.2022.101141
• Publication Date: 2022-12-11T06:25:40Z
• Authors: Julie M. Jiang; Jeremy Eichler; William Bodner; Jana Fox; Madhur Garg; Rafi Kabarriti; Allen Mo; Shalom Kalnicki; Keyur Mehta; Amanda Rivera; Justin Tang; Johnny Yap; Nitin Ohri; Jonathan Klein
• Keywords: Medical physics. Medical radiology. Nuclear medicine; 03 medical and health sciences; 0302 clinical medicine; R895-920; Neoplasms. Tumors. Oncology. Including cancer and carcinogens; Scientific Article; RC254-282; 3. Good health

Financial toxicity (FT) is a significant concern for patients with cancer. We reviewed prospectively collected data to explore associations with FT among patients undergoing concurrent, definitive chemoradiation therapy (CRT) within a diverse, urban, academic radiation oncology department.Patients received CRT in 1 of 3 prospective trials. FT was evaluated before CRT (baseline) and then weekly using the European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire Core-30 questionnaire. Patients were classified as experiencing FT if they answered ≥2 on a Likert scale question (1-4 points) asking if they experienced FT. Rate of change of FT was calculated using linear regression; worsening FT was defined as increase ≥1 point per month. χ2, t tests, and logistic regression were used to assess predictors of FT.Among 233 patients, patients attended an average of 9 outpatient and 4 radiology appointments over the 47 days between diagnosis and starting CRT. At baseline, 52% of patients reported experiencing FT. Advanced T stage (odds ratio, 2.47; P = .002) was associated with baseline FT in multivariate analysis. The mean rate of FT change was 0.23 Likert scale points per month. In total, 26% of patients demonstrated worsening FT during CRT. FT at baseline was not associated with worsening FT (P = .98). Hospitalization during treatment was associated with worsening FT (odds ratio, 2.30; P = .019) in multivariate analysis.Most patients reported FT before CRT. These results suggest that FT should be assessed (and, potentially, addressed) before starting definitive treatment because it develops early in a patient's cancer journey. Reducing hospitalizations may mitigate worsening FT. Further research is warranted to design interventions to reduce FT and avoid hospitalizations.