2129 - Self-Reported Financial Toxicity among Rural Cancer Patients Treated with Radiotherapy

M. L. Rose¹, R. Yen², S. T. Sha³, A. Van Citters², and N. S. Kapadia^2,4; ¹Department of Radiation Oncology and Applied Sciences, Dartmouth Cancer Center, Dartmouth Health, Lebanon, NH, ²Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College, Hanover, NH, ³Geisel School of Medicine, Dartmouth College, Hanover, NH, ⁴Dartmouth Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH

Purpose/Objective(s): Financial toxicity (FT) represents the direct and indirect expenses that cause additional burden on patients within healthcare that affects their wellbeing. FT in cancer care has been linked to decreased treatment compliance and worse outcomes. FT has not been extensively studied in rural cancer populations undergoing radiotherapy. To further our understanding of FT in these patients, we conducted a feasibility study to assess our ability to complete data collection, and identify initial trends for targeted interventions and mitigation strategies. Materials/

Methods: We surveyed radiotherapy patients at a satellite clinic linked to a tertiary academic medical center. Surveys were provided at the time of simulation (baseline), weekly while on treatment, and during any scheduled follow-up visits for six months post-completion of RT. Data elements included demographics, weekly incomes, expenses, travel logistics, COmprehensive Scores for financial Toxicity (COST), perceptions of financial assistance, and a summary measure to report the least meaningful sum of money to improve their financial situation in the past week.
Results: 27 participants consented from 09/2022 to 02/2023. One participant withdrew after baseline. Overall, 93% of weekly surveys contained complete responses. Baseline demographics of the cohort consisted mostly of older (mean age 68 years) white (n=27/27) men (n= 26/27) with prostate cancer (n=18/27). The plurality of patients (44%) reported yearly income less than $48,000; 48% received a high-school education or less. COST scores remained largely stable during weekly treatment (median 9, IQR 3-21, range 0-42.9) and slightly decreased during follow-up (median 4, IQR 0-9, range 0-38). Ten patients (37%) reported that they or family members missed work to provide transportation to the cancer center. When asked what expenses were decreased, most respondents reported spending less on other transportation/gas (n=7), entertainment (n=7), and food (n=6). One participant sold assets to cover costs of cancer treatment. On a 5-point Likert scale participants reported that their providers cared slightly more about patients’ finances than they understood about their finances (3.1 [IQR 2.6 – 4.0] vs 2.7 [1.8 – 3.4]). At baseline, the median sum of money which would make a meaningful difference in respondent’s past week was $211. This did not appreciably change during the course of treatment, though only 55% of follow-up surveys included a response to this question.
Conclusion: FT surveys among a rural radiotherapy population is feasible with high fidelity of data collection. Though the mean COST scores in this pilot cohort did not appreciably change throughout treatment, patients reported significant hardship as evidenced by selling assets, forgoing essential expenses and reporting relatively modest sums that would have changed their financial standing.