Out-of-pocket costs and financial toxicity experienced by patients in early-phase clinical trials.

Authors

Ryan Huey

Ryan Huey

The University of Texas MD Anderson Cancer Center, Houston, TX

Ryan Huey, Goldy George, Penny Phillips, Revenda White, Siqing Fu, Filip Janku, Daniel D. Karp, Aung Naing, Sarina Anne Piha-Paul, Vivek Subbiah, Apostolia Maria Tsimberidou, Shubham Pant, Timothy A Yap, Jordi Rodon Ahnert, Funda Meric-Bernstam, Ya-Chen T. Shih, David S. Hong

Organizations

The University of Texas MD Anderson Cancer Center, Houston, TX, University of Texas MD Anderson Cancer Center, Houston, TX, Department of Investigational Cancer Therapeutics (Phase I Program), The University of Texas MD Anderson Cancer Center, Houston, TX

Research Funding

Other
Institutional Funds.

Background: Clinical trials are an important therapeutic option for cancer patients. Although financial burden in cancer treatment is well-described, the financial burden associated with clinical trials is not well understood, especially for patients with lower socioeconomic status. Methods: We conducted a survey regarding economic burden and financial toxicity among cancer patients on Phase I clinical trials for at least 1 month. Financial Toxicity Score (FTS) was assessed using the validated COmprehensive Score for Financial Toxicity (COST) survey (scale 0-44, lower scores indicating worse financial toxicity). Patients also reported monthly out of pocket (OOP) medical and non-medical expenses. Results: Of 147 consecutive patients approached, 105 agreed to participate; median age = 60y; 62% female; 49% had annual income < $60K; 50% lived < 300 miles from the clinic; 34% required air travel; 41% had Medicare, 50% had employer sponsored insurance. Median FTS = 20, with interquartile range of 12.5. Median monthly OOP costs for non-medical expenses was $985, and for medical expenses was $475. Median total monthly OOP costs was $1695. Compared to patients in the highest quartile of FTS, a significantly lower % of patients in the lowest (worst) quartile of FTS had incomes > $60K (27% v. 77%, P < 0.001), and a significantly higher % were unemployed or not working outside the home (54% v. 12%, P = 0.001), and incurred higher than expected medical (39% vs. 12%, P = 0.025) and non-medical (64% vs. 15%, P = 0.003) expenses. Compared with patients for whom medical costs were not much higher than expected, a significantly higher % of patients with medical costs much higher than expected were non-White (77% v. 46%, P = 0.004) and unemployed/not working outside the home (46% v. 19%, P = 0.009). Conclusions: Among cancer patients participating on clinical trials, economic burden is high and financial toxicity is disproportionally higher in patients with lower income. OOP costs can be substantial and are often unexpected for patients.

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Abstract Details

Meeting

2019 ASCO Quality Care Symposium

Session Type

Rapid Oral Abstract Session

Session Title

Rapid Abstract Session B

Track

Cost, Value, and Policy,Technology and Innovation in Quality of Care,Health Care Access, Equity, and Disparities,Patient Experience,Safety

Sub Track

Value/Cost of Care

Citation

J Clin Oncol 37, 2019 (suppl 27; abstr 8)

DOI

10.1200/JCO.2019.37.27_suppl.8

Abstract #

8

Abstract Disclosures

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