TY - JOUR
T1 - Financial toxicity in gynecologic oncology
AU - Bouberhan, Sara
AU - Shea, Meghan
AU - Kennedy, Alice
AU - Erlinger, Adrienne
AU - Stack-Dunnbier, Hannah
AU - Buss, Mary K.
AU - Moss, Laureen
AU - Nolan, Kathleen
AU - Awtrey, Christopher
AU - Dalrymple, John L.
AU - Garrett, Leslie
AU - Liu, Fong W.
AU - Hacker, Michele R.
AU - Esselen, Katharine M.
N1 - Funding Information:
This work was supported by the Eleanor and Miles Shore 50th Anniversary Fellowship Program and Harvard Catalyst | The Harvard Clinical and Translational Science Center (National Center for Advancing Translational Sciences, National Institutes of Health Award UL 1TR002541) and financial contributions from Harvard University and its affiliated academic healthcare centers. The funding organizations had no role in the preparation, review, or approval of the manuscript.
Funding Information:
This work was supported by the Eleanor and Miles Shore 50th Anniversary Fellowship Program and Harvard Catalyst | The Harvard Clinical and Translational Science Center ( National Center for Advancing Translational Sciences , National Institutes of Health Award UL 1TR002541 ) and financial contributions from Harvard University and its affiliated academic healthcare centers. The funding organizations had no role in the preparation, review, or approval of the manuscript.
Publisher Copyright:
© 2019 Elsevier Inc.
PY - 2019/7
Y1 - 2019/7
N2 - Objectives: Financial toxicity is increasingly recognized as an adverse outcome of cancer treatment. Our objective was to measure financial toxicity among gynecologic oncology patients and its association with demographic and disease-related characteristics; self-reported overall health; and cost-coping strategies. Methods: Follow-up patients at a gynecologic oncology practice completed a survey including the COmprehensive Score for Financial Toxicity (COST) tool and a self-reported overall health assessment, the EQ-VAS. We abstracted disease and treatment characteristics from medical records. We dichotomized COST scores into low and high financial toxicity and assessed the correlation (r) between COST scores and self-reported health. We calculated risk ratios (RR) and 95% confidence intervals (CI) for the associations of demographic and disease-related characteristics with high financial toxicity, as well as the associations between high financial toxicity and cost-coping strategies. Results: Among 240 respondents, median COST score was 29. Greater financial toxicity was correlated with worse self-reported health (r = 0.47; p < 0.001). In the crude analysis, Black or Hispanic race/ethnicity, government-sponsored health insurance, lower income, unemployment, cervical cancer and treatment with chemotherapy were associated with high financial toxicity. In the multivariable analysis, only government-sponsored health insurance, lower income, and treatment with chemotherapy were significantly associated with high financial toxicity. High financial toxicity was significantly associated with all cost-coping strategies, including delaying or avoiding care (RR: 7.3; 95% CI: 2.8–19.1). Conclusions: Among highly-insured gynecologic oncology patients, many respondents reported high levels of financial toxicity. High financial toxicity was significantly associated with worse self-reported overall health and cost-coping strategies, including delaying or avoiding care.
AB - Objectives: Financial toxicity is increasingly recognized as an adverse outcome of cancer treatment. Our objective was to measure financial toxicity among gynecologic oncology patients and its association with demographic and disease-related characteristics; self-reported overall health; and cost-coping strategies. Methods: Follow-up patients at a gynecologic oncology practice completed a survey including the COmprehensive Score for Financial Toxicity (COST) tool and a self-reported overall health assessment, the EQ-VAS. We abstracted disease and treatment characteristics from medical records. We dichotomized COST scores into low and high financial toxicity and assessed the correlation (r) between COST scores and self-reported health. We calculated risk ratios (RR) and 95% confidence intervals (CI) for the associations of demographic and disease-related characteristics with high financial toxicity, as well as the associations between high financial toxicity and cost-coping strategies. Results: Among 240 respondents, median COST score was 29. Greater financial toxicity was correlated with worse self-reported health (r = 0.47; p < 0.001). In the crude analysis, Black or Hispanic race/ethnicity, government-sponsored health insurance, lower income, unemployment, cervical cancer and treatment with chemotherapy were associated with high financial toxicity. In the multivariable analysis, only government-sponsored health insurance, lower income, and treatment with chemotherapy were significantly associated with high financial toxicity. High financial toxicity was significantly associated with all cost-coping strategies, including delaying or avoiding care (RR: 7.3; 95% CI: 2.8–19.1). Conclusions: Among highly-insured gynecologic oncology patients, many respondents reported high levels of financial toxicity. High financial toxicity was significantly associated with worse self-reported overall health and cost-coping strategies, including delaying or avoiding care.
KW - Costs of cancer care
KW - Financial burden
KW - Financial toxicity
KW - Gynecology oncology patients
KW - Patient reported outcomes
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U2 - 10.1016/j.ygyno.2019.04.003
DO - 10.1016/j.ygyno.2019.04.003
M3 - Article
C2 - 31053404
AN - SCOPUS:85064896215
SN - 0090-8258
VL - 154
SP - 8
EP - 12
JO - Gynecologic oncology
JF - Gynecologic oncology
IS - 1
ER -