Assessing financial toxicity with COST-FACIT: experience from a tertiary care cancer center

Financial toxicity (FT) refers to the direct and indirect consequences of cancer diagnosis and treatment and is a key mediator of quality of life (QOL) and survival in cancer patients. To address this, financial navigation (FN) programs have been implemented in many cancer centers. At our large tertiary care cancer center, the FN program uses the Comprehensive Score for Financial Toxicity (COST) to screen patients undergoing first cancer treatment. We aimed to better understand FT, risk factors, and association with outcomes in our cancer population.

We identified 1906 patients with any cancer diagnosis and a completed COST between 6/2021 and 2/2024. Sociodemographic data including the Area Deprivation Index (ADI), disease, and treatment characteristics as well as patient-reported outcomes (PROMIS10, PHQ9 and NCCN DT) were collected. Risk factors for FT and association of FT on overall survival (OS) were analyzed.

Median age was 65 years (IQR 56-72); 54% female, 82% white, 57% married, 47% insured privately, and 35% with Medicare. Younger age, race/ethnicity, insurance type, tobacco use, and higher ADI were associated with higher FT. Higher distress (NCCN DT, N = 1001) and lower physical (N = 1474) and mental (N = 1505) health (PROMIS10) were also associated with higher FT. FT was not associated with time to treat (TTT) or OS. However, higher ADI was significantly associated with TTT (HR 0.98, 95% CI 0.96-1.00, p = 0.04) but not OS.

Our study provides insights into risk factors for FT in a large cancer population. We did not demonstrate a significant association of FT on survival. Further analysis in specific disease groups is needed to better understand these relationships.