(P 199) FINANCIAL TOXICITY AMONG SARCOMA PATIENTS AND ASSOCIATED FACTORS

Objective: Financial toxicity is linked to decreased quality of life and outcomes in cancer patients. Studies in countries with universal healthcare have demonstrated greater financial distress among patients with sarcoma, while no similar data are available in the United States. In a cohort of sarcoma patients treated at Vanderbilt University Medical Center (VUMC) Sarcoma Treatment Center we evaluated the prevalence and associated risk factors of financial toxicity.

Methods: Participants were enrolled in the “Cohort to Augment the Understanding of Sarcoma Survivorship Across the Lifespan” (CAUSAL) study, a cohort study to understand sarcoma survivorship through the lifespan. Patient and disease characteristics were abstracted from the electronic medical record. The Comprehensive Score for Financial Toxicity (COST) measure was administered at enrollment to assess financial toxicity, where lower scores indicate higher financial toxicity. Associations between participant and disease characteristics with COST scores were evaluated using linear regression models. Subgroup analyses were performed among participants defined as: “Treatment Naïve” (enrolled at diagnosis/no prior therapy), “Recently Treated” (last treated within 1 year of enrollment), or “Previously Treated” (last treated >1 year prior to enrollment). Therapy includes chemotherapy, targeted therapy, surgery, or radiation.

Results: Among 1244 participants enrolled to date, 804 completed the COST and are included in this analysis. The median score among all participants is 28 (Quartiles: 18-35). Subgroups include Treatment Naïve (N=324, 40%), Recently Treated (N=275, 34%), and Previously Treated (N=205, 26%), with median scores of 29 (19-35), 27 (18-35), and 28 (18-25), respectively. Among all participants, male gender is associated with an average lower toxicity of 1.6 points (95% CI, 0.2-1.9). Compared with 18-39 years, age 65 years has a lower toxicity by 4.9 (2.0-7.8) points. Compared with income <$25k, incomes of $25k-$45k, $45k-$65k, $65k-$90k, $90k-$120k and >$120k are associated with lower toxicity of 3.1 (0.3-6.0), 6.0 (3.1-9.0), 8.8 (5.8-11.7), 11.1 (8.0-14.1), and 13.6 (10.6-16.6), respectively. Among the Treatment Naïve subgroup, male gender has an average lower toxicity of 2.2 (0.1-4.3), “separated/widowed” vs married with an average 7.0 (1.6-12.3), and retirement vs employed with an average 3.4 (0.2-6.6). Among the Recently Treated subgroup, age >65 years and Retirement have a lower toxicity by 5.7 (0.9-10.5), 4.4 (0.7-8.0) points, respectively. Non-white race (Ref: white) and Medicare (Ref: commercial insurance) have a higher toxicity with an average 5.6 (1.9-9.3) and 5.1 (0.6-9.6) points, respectively. Among the Previously Treated subgroup, age >65 years and male have a lower toxicity with average 6.9 (0.7-13.1) and 3.6 (0.7-6.6) points, respectively. One member increase in households is associated with an increase of 1.4 (0.1-2.8) points of financial toxicity. The income levels in the three subgroups showed similar results among all participants.

Conclusion: Among all participants, lower financial toxicity is associated with older age (>65 years), male gender, and high income. Retirement was associated with lower toxicity among Treatment Naïve and Recently Treated participants. Among Recently Treated participants, non-white race and Medicare were associated with increased toxicity. Among previously Treated participants, households with more members demonstrated increased toxicity. Time from diagnosis did not influence scores. These results may enable providers to identify patients at risk for financial toxicity and connect them with resources.