2943 - COST-FACIT Analysis of Cancer Patients Treated with Radiotherapy in a Publicly Funded Healthcare System in One Country

M. Skubic¹, K. Vörös¹, M. Bavdaz², T. Redek², A. Perhavec^1,3, P. Dosenovic Bonca², I. Ratosa^1,4, and B. H. Zobec Logar^1,4; ¹Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia, ²Faculty of Economics, University of Ljubljana, Ljubljana, Slovenia, ³Division of Surgical Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia, ⁴Institute of Oncology Ljubljana, Ljubljana, Slovenia

Purpose/Objective(s): Studies suggest that financial toxicity (FT) exists even in countries with a well-developed public health system. In our country, which has a publicly funded health care system, FT has not been measured yet. The aim of this study was to assess the extent of FT based on validated instrument measuring financial distress among people with cancer undergoing radiotherapy. Materials/

Methods: The Comprehensive Score for Financial Toxicity–Functional Assessment of Chronic Illness Therapy (COST-FACIT) questionnaire-v.2 was used. The study was prospective and cross-sectional and ran from 1 June 2023 to 16 October 2023. The sample included patients who were on therapy or followed-up during the study period. FT was categorised into four different grades based on the COST-FACIT score: G0 with a score of =26 (no FT), G1 with a score of 14-25 (mild FT), G2 with a score of 1-13 (moderate FT), and G3 with a score of 0 (severe FT). The normality of the variables was assessed using their skewness statistics and normal probability plots. The subscale and total scores of the COST-FACIT-v2 were presented as means and SDs. Kruskal-Wallis was used to compare means. Internal consistency was assessed using Cronbach’s alpha. The intraclass correlation coefficient (ICC) was used to assess the test–retest reliability of the scale.
Results: 440 patients were included in the analysis, with a mean age of 64.2 ± 12.1 years. The most common cancers were breast cancer (20%), prostate cancer (18.9%), lung cancer (16.2%) and head and neck cancer (11.3%). The majority (55.7%) of patients were retired, 83.4% had a secondary education or higher, 52.0% were from rural areas and 14.8% of patients lived alone. The average household income per month was between 600-900 euros per person, 41.8% had more than 900 euros and 19.5% less than 600 euros. 99.8% of patients had health insurance. 64.5% of patients were in active treatment, 16.8% had a recurrent disease. The mean COST-FACIT score was 26.7 ± 8.8. FT grades are shown in Table 1. The Cronbach’s alpha for the COST-FACIT measure was 0.778, indicating acceptable internal consistency, and the ICC was 0.730 (95% confidence interval: 0.691–0.766), indicating acceptable test–retest reliability. A higher FT was found in breast cancer patients (p=0.028), younger =65 years (p<0.001), patients undergoing active treatment (p<0.001) and in low income households (p<0.001).
Conclusion: To summarize, FT was absent or mild in the majority of patients. Risk factors for higher financial toxicity were breast cancer, low monthly net income per person, younger patients and patients undergoing active treatment.

Abstract 2943 – Table 1

FINANCIAL TOXICITY GRADE	N (%)
G0	245 (55.7%)
G1	137 (31.1%)
G2	32 (7.3%)
G3	1 (0.2 %)
N-number of patients A total of 25 patients (5.8%) did not complete the COST-FACIT questionnaire.