Background
The cost of cancer care is high and rising. Evidence of increased patient cost burden
is prevalent in the medical literature and has been defined as “financial toxicity,”
the financial hardship and financial concerns experienced by patients because of a
disease and its related treatments. With targeted therapies and growing out-of-pocket
costs, patient financial toxicity is a growing concern among patients with gynecologic
cancer.
Objective
This study aimed to determine the prevalence of financial toxicity and identify its
risk factors in patients with gynecologic cancer treated at a large cancer center
using objective data.
Study Design
Using institutional databases, we identified patients with gynecologic cancer treated
from January 2016 to December 2018. Patients with a preinvasive disease were excluded.
Financial toxicity was defined according to institutionally derived metrics as the
presence of ≥1 of the following: ≥2 bills sent to collections, application or granting
of a payment plan, settlement, bankruptcy, financial assistance program enrollment,
or a finance-related social work visit. Clinical characteristics were gathered using
a 2-year look-back from the time of the first financial toxicity event or a randomly
selected treatment date for those not experiencing toxicity. Risk factors were assessed
using chi-squared tests. All significant variables on univariate analysis were included
in the logistic regression model.
Results
Of the 4655 patients included in the analysis, 1155 (25%) experienced financial toxicity.
In the univariate analysis, cervical cancer (35%), stage 3 or 4 disease (24% and 30%,
respectively), younger age (35% for age <30 years), nonpartnered marital status (31%),
Black (45%) or Hispanic (37%) race and ethnicity, self-pay (48%) or commercial insurance
(30%), clinical trial participation (31%), more imaging studies (39% for ≥9), ≥1 emergency
department visit (36%), longer inpatient stays (36% for ≥20 days), and more outpatient
clinician visits (41% for ≥20 visits) were significantly associated with financial
toxicity (P<.01). In multivariate analysis, younger age, nonpartnered marital status, Black and
Hispanic race and ethnicity, commercial insurance, more imaging studies, and more
outpatient physician visits were significantly associated with financial toxicity.
Conclusion
Financial toxicity is an increasing problem for patients with gynecologic cancer.
Our analysis, using objective measures of financial toxicity, has suggested that demographic
factors and healthcare utilization metrics may be used to proactively identify at-risk
patients for financial toxicity.
Key words
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Article Info
Publication History
Published online: December 10, 2021
Accepted:
December 8,
2021
Received in revised form:
December 6,
2021
Received:
September 23,
2021
Footnotes
E.M.A. and B.L.M.G. are cofirst authors.
Outside the submitted work, M.M.L. Jr reports personal fees from Johnson & Johnson and Ethicon, Takeda, and Intuitive Surgical , Inc. Furthermore, he reports institutional research funding from Kinetic Concepts/Acelity. N.R.A.R reports grants from Stryker/Novadaq and GRAIL. D.S.C. reports personal fees from Bovie Medical Corporation; Verthermia, Inc (now Apyx Medical Corporation); Biom'Up, and CSurgeries and other grants from Intuitive Surgical, Inc; Doximity, and TransEnterix, Inc. E.L.J reports personal fees from Covidien/Medtronic. The remaining authors report no conflict of interest.
This study was funded, in part, through the National Institutes of Health /National Cancer Institute Cancer Center Support Grant P30 CA008748.
Cite this article as: Aviki EM, Manning-Geist BL, Sokolowski SS, et al. Risk factors for financial toxicity in patients with gynecologic cancer. Am J Obstet Gynecol 2022;226:817.e1-9.
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