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Patient-Reported Financial Toxicity of Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy
Vladislav Kovalik1, Armando Sardi2, Luis Felipe Falla-Zuniga1
1Mercy Medical Center, Baltimore, MD, USA.
Background:
Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) may lead to financial toxicity (FT), potentially impairing survivors' quality of life (QoL). We assessed FT from the perspective of CRS/HIPEC candidates and survivors, hypothesizing an association with QoL, and explored its dynamics and drivers.
Patients And Methods:
A cross-sectional, single-center study used in-person Comprehensive Score for Financial Toxicity (COST) (FT) and Functional Assessment of Cancer Therapy-General (FACT-G) (QoL) surveys among CRS/HIPEC candidates/survivors with various primary tumors up to 5 years postoperatively. Spearman correlation between COST and FACT-G was assessed. Risk factors for FT were identified using a generalized linear model with forward selection among clinical, sociodemographic, and financial variables, as well as time from CRS/HIPEC.
Results:
Overall, 248 surveys were analyzed: 55 (22.2%) candidates and 193 (77.8%) survivors. Mean ± standard deviation (SD) age was 59 ± 11 years, and 75% were female individuals. Appendix cancer was the most prevalent (42.3%), followed by ovarian (33.9%), colon (14.5%), and other (9.3%). The mean ± SD COST score was 29.7 ± 10.7 (range: 0-44), with 31.0% experiencing moderate-to-severe FT (COST ≤ 25). COST and FACT-G scores were strongly correlated (rho = 0.51, p < 0.001). Risk factors for greater FT (p < 0.05) included preoperative (β = -3.7) and adjuvant chemotherapy (β = -3.2), identifying as Black, Indigenous, or person of color (β = -5.4), being single (β = -3.5), and higher co-pays within 90 days before/after CRS/HIPEC (β range: -3.0 to -3.9). FT decreased over time (p = 0.008), reaching its lowest levels by 1 year postoperatively.
Conclusions:
FT is strongly associated with poorer QoL among CRS/HIPEC candidates/survivors. Risk factors include perioperative chemotherapy, higher co-pays from perioperative care, and sociodemographic disadvantages. Financial well-being improves by 1 year post-CRS/HIPEC.
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