Financial Toxicity among Survivors of Extremity and Pelvic Sarcoma: A Retrospective Study

Financial toxicity in oncology, defined as the economic burden and psychosocial distress of cancer care, has been associated with poor clinical outcomes. Despite high projected treatment costs, data on financial toxicity in patients with sarcoma remain limited. This study aimed to characterize financial toxicity in survivors of sarcoma and to better inform screening practices for patients with rare cancers requiring complex, multidisciplinary treatment plans.

This retrospective cohort study surveyed patients with a diagnosis of trunk or extremity sarcomas between 2016 and 2024 (i.e., survivors of sarcoma). Patients were administered the COmprehensive Score for Financial Toxicity (COST) instrument, which has been validated with cancer patients. Scores ranged from 0 to 44. Financial toxicity was categorized into moderate-to-severe (score <26) and low-to-none (score ≥26) groups. Demographic and clinical variables were obtained from electronic medical records. Univariate logistic regression analyses were used to explore variables associated with financial toxicity.

Among 205 participants, 77 % reported moderate-to-severe financial toxicity. The odds of financial toxicity were similar across insurance types, race, ethnicity, employment status, income, and geography. Patients were less likely to report financial toxicity if they had soft tissue sarcomas (compared with bone sarcomas; odds ratio, 0.43; 95% confidence interval, 0.18-0.98).

Financial toxicity is highly prevalent among survivors of sarcoma. The widespread nature of this financial distress across different patient groups suggests that no specific population is disproportionately affected, underscoring the universal risk of financial toxicity. These findings support exploring universal financial toxicity screening for patients with sarcoma to facilitate timely interventions.