Prevalence and Risk Factors for Financial Toxicity Among Sarcoma Patients During and Following Treatment Across the Lifespan

Abstract

Background

Financial toxicity (FT) describes the impact of cancer and treatment-related financial burden. We evaluated the prevalence and risk factors for FT among sarcoma patients.

Methods

A sarcoma cohort was constructed to assess health outcomes. FT was measured via “COmprehensive Score for financial Toxicity” (COST), where lower scores indicate greater FT. COST scores were evaluated in association with patient demographics, clinical data, and psychosocial/functional domains (PROMIS-57) using multivariable linear regression. Subgroup analyses evaluated patients on- versus off-therapy.

Results

Among 1125 participants (515 on/610 off therapy), median COST was 27.0 (IQR 18.0, 35.0), with absent, mild, moderate, and severe FT seen in 55.4%, 29.2%, 15.1%, and 0.4%, respectively. Lower FT was associated with increasing age (+1.28; 95% CI 0.86, 1.70), male sex (+1.93; 0.78, 3.08), and higher income (+0.87; 0.72, 1.01). Increased FT was associated with non-White race (−1.79; −3.41, −0.13), larger households (−0.73; −1.25, −0.22), metastatic disease (−2.36; −3.80, −0.91), and active treatment (−1.61; −2.97, −0.24). Subgroup analyses demonstrated similar results regarding age, sex, income, and metastatic disease among on-therapy and age, income, and household members among off-therapy. Eight hundred and thirty-two participants completed both the PROMIS-57 and COST. FT was associated with anxiety (−0.77; −1.45, −0.08), depression (−2.11; −2.96, −1.26), pain interference (−1.36; −2.17, −0.55), and sleep disturbance (−0.68; −1.35, −0.004).

Conclusion

Almost half of participants experienced FT. Risk factors included non-White race, active therapy, larger households, and metastatic disease. Anxiety, depression, pain interference, and sleep disturbance were associated with FT. Screening for FT is needed to develop targeted interventions.