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Screening for Financial Toxicity and Health-Related Social Risks in Patients With GI Cancer: Results From a Large
Aditya Narayan1, Kaitlyn Lapen2, Edward Christopher Dee2
1School of Medicine, Stanford University, Palo Alto, CA.
Purpose:
Patients with GI cancers often face significant financial toxicity (FT) and health-related social risks (HRSRs), yet best practices for screening remain unclear. This study aimed to evaluate the prevalence of FT and HRSR and identify associated factors.
Methods:
From June 2022 to August 2023, patients were screened using the Comprehensive Score for Financial Toxicity (COST), patient-reported HRSR (eg, housing, food insecurity), and quality of life (QOL). Multivariate regressions were used to assess predictors of FT and HRSR, adjusting for several variables.
Results:
Among 8,335 patients with GI cancer, 45% had a COST score of <26, indicating FT. In adjusted linear regression, FT was associated with racial/ethnic minority status (β, 4.20; P < .001), advanced disease (stage III [β, 1.33; P < .001]; IV [β, 1.56; P < .001]), recent treatment (β, 3.23; P < .001), and anal (β, 1.97; P = .003), esophageal (β, 1.66; P = .005), or hepatobiliary cancer (β, 1.05; P = .031). Older age (≥65 years [β, -5.17; P < .001]), higher income ($100,000-$200,000 [β, -1.81; P < .001]; >$200,000 [β, -3.80; P < .001]), and private insurance (β, -1.70; P < .001) were protective. Twenty-eight percent reported at least one HRSR. HRSRs were associated with minority status (odds ratio [OR], 2.14; P < .001), advanced disease (stage III [OR, 1.31; P = .001]; IV [OR, 1.24; P = .010]), recent treatment (OR, 1.20; P = .001), and gastric cancer (OR, 1.25; P = .027). Lower HRSR was associated with older age (OR, 0.59; P < .001), higher income ($100,000-$200,000 [OR, 0.66; P < .001]; >$200,000 [OR, 0.48; P < .001]), and private insurance (OR, 0.64; P < .001). Sex was not a predictor. Worst FT was associated with decreased QOL (β, -0.98; P < .001) and reduced medication adherence (β, 0.11; P < .001).
Conclusion:
High levels of FT and HRSR were observed in patients with GI cancer. Early intervention to address financial and social burdens may improve both disease and survivorship outcomes.
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