Objective predictors of financial toxicity in oncology

Current financial toxicity (FT) screening tools rely on patient-reported risk factors. Underrepresented populations may not be forthcoming about FT fears due to cultural concerns of treatment withholding or migratory repercussions, if applicable. Identifying objective risk factors, such as social determinants of health (SDOH) and disease-specific factors (DSF), could reduce FT in patients with cancer and throughout health care systems.

This was a multicenter retrospective study evaluating SDOH and DSF associated with FT (defined as ≥ $15,000 owed) related to cancer treatment. Inferential statistics were used to evaluate differences between the FT cohort and those who owed less than $15,000. Continuous data were compared with a Student t test or Mann-Whitney test, depending on distribution. Categorical outcomes were compared with a χ² test. A logistic regression model was used to evaluate multivariate associations with FT, using a P value of less than .05 to define significant results.

The sample comprised 162 records, 81 in each group. Univariate analyses demonstrated participants' differences in age, relationship with a primary care provider, country of origin, insurance status, education level, need for an English interpreter, whether their disease was stage IV at diagnosis, recurrent or metastatic disease, use of immune checkpoint inhibitors, and use of targeted molecular therapy. Employment status and marital status were not statistically different. The logistic regression model showed that lack of insurance and having stage IV disease at diagnosis were significantly associated with FT (P = .001 and P = .0495, respectively).

Objective FT screening can minimize response bias and incidence in those at increased risk. In our study, we found that individuals who are first-generation Hispanic immigrants and lack English proficiency faced significant barriers to receiving help for the high financial costs of medical care. These findings identify specific subpopulations at risk for FT and will guide prospective interventions looking to minimize FT. Health care systems should analyze objective measures of FT while considering loco-regional and subcultural SDOH/DSF to overcome response bias.