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

Purpose/Objective(s) Financial toxicity (FT) is an increasingly recognized concern for cancer patients. We reviewed prospectively collected data to explore factors associated with FT among patients undergoing concurrent chemotherapy and radiation therapy (CRT) within an urban, academic radiation oncology department serving a diverse patient population. Materials/Methods The study population was drawn from three prospective trials at our institution of patients receiving concurrent curative-intent CRT. FT was evaluated using weekly EORTC QLQ-C30 questionnaire assessments during the concurrent CRT course. FT was rated on a 4-point Likert scale ranging from experiencing “no” FT to “very much”. Patients were classified as having FT if they answered anything other than “no”. Rate of change of FT per 30 days was calculated for each patient using linear regression. Those with a rate of increase ≥ 1 point per month were categorized as having treatment-related FT. Chi squared, t test, and logistic were used as appropriate to assess patient demographics, tumor characteristics, and hospitalization as predictors of FT. Results 235 patients were included: 32% had head & neck cancer, 29% gastrointestinal primary, 27% lung cancer, 9% cervix cancer, and 4% glioblastoma multiforme. 34% of the study population identified as Black or African American, and 38% identified as Hispanic. On average, patients completed QLQ-C30 5.4 times. Before starting CRT, 52% of patients reported experiencing at least some FT. Higher T stage (P = 0.003) was associated with FT before CRT on bivariate analyses. On multivariate analysis, younger age (OR = 1.06, P = 0.02) was associated with higher FT before CRT after adjusting for age, race, insurance, socioeconomic status, and stage. The mean rate of change in FT was 0.23 points per month. 26% of patients demonstrated treatment-related FT. Experiencing FT before CRT was not associated with treatment-related FT (P = 0.693). Hospitalization during RT (P = 0.015) and cervical cancer diagnosis (P = 0.032) were associated with treatment-related FT. On multivariate analyses, hospitalization (OR 2.92, P = 0.008) was associated with treatment-related FT after adjusting for age, race, insurance, and stage. Conclusion Over half of patients reported FT prior to starting CRT. Reassuringly, most patients did not experience a significant increase in FT over the course of concurrent CRT. However, around a quarter of patients did experience treatment-related FT, which was associated with hospitalization during treatment. The finding that patients experience FT prior to CRT start suggests that FT should be evaluated as soon as cancer is diagnosed to allow for early intervention. Further research will help define mechanisms of FT and design interventions to improve FT and avoid hospitalizations.