Baseline Financial Toxicity and Cost-Coping Mechanisms Among Patients Presenting for Radiation Therapy

Financial toxicity (FT) is an increasingly recognized barrier to high-quality cancer care, yet data describing FT at the initiation of radiation therapy across cancer types are limited. We evaluated the prevalence of FT and its associations with demographic factors, clinical characteristics, and cost-coping behaviors among patients starting radiation therapy at a tertiary academic center.

Adult patients scheduled to begin radiation therapy completed a pretreatment survey as part of a prospective longitudinal study. The survey included the 12-item Comprehensive Score for Financial Toxicity tool, demographic and clinical variables, and cost-coping behaviors. High FT was defined as a Comprehensive Score for Financial Toxicity score ≤22 (top tertile). We used χ², Fisher's exact, and Wilcoxon rank-sum tests to compare high and low FT groups and log-binomial regression to estimate risk ratios (RRs) for cost-coping behaviors.

Among 265 respondents, 35% (n = 94) had high FT. These patients were younger, and more likely to be unmarried, have lower income and education, and speak a language other than English (all P ≤ 0.02). Self-reported race/ethnicity, income, type of cancer, and receipt of chemotherapy also differed by FT (all P ≤ .001). Compared with patients with low/no FT, those with high FT were more likely to reduce or stop work (21% vs 7%; P < .001), delay medical care (RR, 13; 95% CI, 4-43), borrow money (RR, 10; 95% CI, 4-26), and cut back on essential goods (RR, 7; 95% CI, 3-16). Parking and transportation costs also more frequently influenced medical decisions (24% vs 6%; P < .001).

High FT was common at radiation therapy initiation and associated with social determinants of health and clinical factors. It was strongly linked to behaviors that may negatively impact outcomes, highlighting the need for early FT screening and targeted interventions during radiation therapy planning.