(P 210) FINANCIAL TOXICITY ASSOCIATED WITH THE TREATMENT OF SARCOMAS: A SINGLE INSTITUTION RETROSPECTIVE-PROSPECTIVE STUDY

Objective: Financial toxicity has been linked to decreased quality of life and outcomes in cancer patients. Sarcoma patients can have long, complex treatment courses, which often involve some combination of surgery, chemotherapy, and radiation. Prior studies in countries with universal healthcare, such as Germany, have demonstrated higher levels of financial distress in patients with sarcoma, compared to an age and gender-matched general population. In the present study, sarcoma patients treated at Vanderbilt University Medical Center (VUMC) Sarcoma Treatment Center, which is amongst the largest sarcoma programs in the US, were evaluated for financial toxicity.

Methods: Participants were enrolled in the “Cohort to Augment the Understanding of Sarcoma Survivorship Across the Lifespan” (CAUSAL) study, a retrospective-prospective cohort study to understand sarcoma survivorship through the lifespan. Patient and tumor characteristics were abstracted from the electronic medical record. The Comprehensive Score for Financial Toxicity (COST) validated questionnaire was administered at enrollment to assess financial toxicity, where lower scores indicate higher financial toxicity.

Results: Of 736 participants enrolled in CAUSAL to date and treated between 2012 to present, 494 completed a COST questionnaire and are included in this analysis. Median COST score at enrollment was 28 (18-35). Higher financial toxicity was not associated with any patient demographics including age, race, education level, and marital status. Higher financial toxicity was also not associated with various tumor or treatment-related factors, including number of treatments, receiving or having completed treatment, tumor size, or tumor location. Female participants demonstrated greater financial toxicity than male participants (p=0.045). The median COST score for participants described as “Out of Work” is 18. Compared with the participants employed for wages, financial toxicity was significantly higher in participants that reported they were temporarily out of work (p=0.044). The median COST score for participants with an income <$45,000 is 19. Participants with higher income were less likely to experience financial toxicity; all income levels above $45,000 demonstrated a p value < 0.01. Compared to participants with commercial insurance, financial toxicity score was significantly higher in participants with Medicaid (p=0.026), and significantly lower in participants insured with Medicare (p=0.022).

Conclusion: Higher levels of financial toxicity were associated with individuals who were out of work and had lower income. These findings may enable providers to better identify patients who are at risk for financial toxicity and connect them with resources. This may ultimately improve patients’ abilities to complete treatments as well as reduce stress. With ongoing accrual in CAUSAL, we will further evaluate predictors of financial toxicity in order to develop supportive interventions to improve patient outcomes.