Financial toxicity in pediatric and adolescent neurosurgical oncology

Financial toxicity (FT) encompasses the negative impact of medical costs on patients. In-depth analysis of FT in pediatric and adolescent neurosurgical oncology has not been performed. The aim of this study was to determine the incidence of FT in this population.

A retrospective review of medical and financial services data was conducted at Memorial Sloan Kettering Cancer Center of patients under 21 years of age who underwent neurosurgery for a cancer-related diagnosis from 2016 to 2020.

294 surgical procedures across 202 patients were analyzed. 16% (33/202) of patients experienced FT in the two years prior to the first neurosurgical procedure, and the most common toxicity identifier was utilization of the financial assistance program (45%). For all 202 patients, the 2-year cumulative incidence of FT following first neurosurgical procedure was 19% (CI:14%,24%). Among patients who survived for at least 2 years after surgery, 34% (29/86) experienced FT with the most common toxicity being having bills sent to collections (34%). Most patients who experienced FT had at least one commercial insurance policy. Presence of pre-operative FT was associated with a significantly higher cumulative incidence of post-operative FT (2-year estimates: pre-operative FT 61% (95%CI: [41%,75%]) vs. no pre-operative FT 11% (95%CI: [7%,16%]), p < 0.001).

FT poses challenges in the pediatric neurosurgical oncology population. Pre-operative FT significantly influences post-operative FT. Most patients who experienced FT had at least one commercial insurance plan, providing evidence that even patients with insurance are not immune to FT.