Patient-reported drivers of financial toxicity in gynecologic cancers: A focus group study (337)

ABSTRACT

Objectives: We aimed to better understand how treatment-related financial burden affects gynecologic cancer patients and identify targets for future interventions to reduce financial toxicity. Methods: Patients with invasive gynecologic cancer diagnoses were invited to participate in a qualitative focus group study. Each participant first completed an online, secure survey that included questions regarding diagnosis, mode of treatment, employment status, and income. The Comprehensive Score for Financial Toxicity (COST) tool was used to measure economic burden (COST score 0-44), with lower scores demonstrating worse financial toxicity. Each participant then took part in one of four virtual semi-structured focus groups through a secure video platform with a social worker and a study staff member. Three investigators independently analyzed the transcripts for common themes and reconciled disagreement through consensus. Results: Of the 13 participants, over 60% had private insurance, and 54% had moderate to high financial toxicity (COST scores <23). The five most commonly discussed themes included the extent of insurance coverage, out-of-pocket health expenses, changes in employment status, inefficient care coordination, and opportunity costs. Other themes that were discussed included stress associated with diagnosis, delays in care, confusion with medical bills, and impacts of COVID-19. Three participants suggested consolidation of bills to decrease obscurity with billing, and two attributed a slower recovery process to financial stress. Participants with worse financial toxicity (COST score <23) reported strain associated with opportunity costs, confusion with billing, and employment status changes more often than those with mild financial toxicity (COST score ≥23). Concerns about insurance coverage were universally reported, irrespective of participant financial toxicity score. Conclusions: Financial toxicity is an increasingly recognized obstacle for patients with gynecologic cancer, though efforts to alleviate patient burdens are lacking. The findings of this study suggest that patient-centered interventions to optimize insurance coverage and enhance care coordination could reduce financial toxicity. This is important given that both targets are potentially immediately actionable and could have downstream effects on health outcomes. Meanwhile, advocacy efforts to improve work leave policies and reduce out-of-pocket health expenditures through insurance reform are broader system-level interventions that also should be considered to curtail financial toxicity.