Risk of Financial Toxicity Among Adults Undergoing Lung and Esophageal Resections for Cancer

Although financial toxicity, defined as the harmful financial burden experienced by patients undergoing cancer treatment, has been of growing interest, data in thoracic oncology are lacking. This study aimed to examine the risk of financial toxicity among patients undergoing surgical resection of thoracic malignant diseases.

Adults undergoing lobectomy, pneumonectomy, or esophagectomy for cancer were identified in the 2012 to 2021 National Inpatient Sample. Risk of financial toxicity was defined as health expenditure (total hospitalization costs for the uninsured and maximum out-of-pocket costs for the insured) exceeding 40% of postsubsistence income. Multivariable logistic regressions were used to identify factors associated with financial toxicity risk.

Of 384,340 patients, 69.5% had government-funded insurance, 27.2% had private insurance, and 1.0% were uninsured. Compared with patients with insurance, uninsured patients were more commonly Black and Hispanic and less commonly electively admitted. Mortality, complications, length of stay, and costs were comparable regardless of insurance status. Approximately 68.9% of uninsured and 17.3% of insured patients were at risk of financial toxicity, and the incidence of financial toxicity remained stable over time. After risk adjustment, complications were associated with a greater than 2-fold increased risk of financial toxicity among uninsured patients (adjusted odds ratio, 2.21; 95% CI, 1.38-3.55). Among the insured patients, Black, Hispanic, and publicly insured patients demonstrated a greater risk of financial toxicity, while patients undergoing minimally invasive operations and receiving care at metropolitan hospitals exhibited a lower risk of financial toxicity.

Concordant with previous work examining financial toxicity in abdominal oncologic surgery, thoracic surgery demonstrates a comparable burden of financial toxicity. Referral policies and care subsidization may be considered in patients at risk for financial toxicity who are undergoing resections for thoracic malignant diseases.