Financial Toxicity High in Patients with Gynecologic Cancer

Meg Barbor, MPH

June 2018, Vol 8, No 6 - Gynecologic Cancers


Approximately 25% of women with gynecologic malignancies cannot afford the cost of their medical care, according to a study presented at the 2018 Society of Gynecologic Oncology Annual Meeting on Women’s Cancer.

“Financial toxicity is common and underrecognized in women with gynecologic cancers, and it affects all income and socioeconomic levels. It also affects overall prognosis and survival,” said Sudeshna Chatterjee, MD, Gynecologic Oncology Fellow, Columbia University Irving Medical Center, New York City, who presented the study results.

Research has shown that individuals with a cancer diagnosis are more than twice as likely to file for bankruptcy than those without cancer. The National Cancer Institute estimates that by 2020 the cost of cancer care will increase by 66% relative to 2010. But financial toxicity is not just about finances.

The financial hardship associated with cancer has been shown to adversely affect the patient’s quality of life, adherence to treatment, and disease outcomes.

Patient Survey

Dr Chatterjee and colleagues investigated the impact of financial toxicity experienced by patients receiving chemotherapy for gynecologic malignancies. Their 10-month cross-sectional study was based on a 35-item survey administered to patients at the time of their treatment.

The survey was scored using the 11-item validated Comprehensive Score for Financial Toxicity measure, which assesses financial toxicity using a score range of 0 to 44, and 22 or more indicates financial toxicity.

The study included 120 women (mean age, 64 years) who completed the survey. The majority of respondents were non-Hispanic white, and the rest of the population was approximately equally divided between Hispanic and African-American patients.

Overall, 23% of patients had an annual income of less than $20,000, and 33% had more than a $100,000 annual income; the rest fell somewhere in between. Most of the patients had ovarian cancer.

Across all income levels, 42% of the patients had financial toxicity scores of 22 or more, which is consistent with the stress caused by financial toxicity, Dr Chatterjee said. Of that subset, 33% of patients also reported nonadherence to treatment, such as skipping appointments or medications, because of financial difficulties.

Approximately 32% of patients reported a decrease in income since receiving a cancer diagnosis, with 10% earning less than 50% of their previous income. In addition, 58% did not save any money in the year of cancer treatment, 34% made financial sacrifices because of cancer, 27% withdrew money from their savings and retirement accounts to pay for their cancer treatments, and 20% were in debt because of treatment.

The survey also revealed issues with insurance and adherence: 37% of patients experienced insurance denials for recommended treatments, including chemotherapy, immunotherapy, antinausea and pain medications, and antibiotics.

Approximately 50% of patients had out-of-pocket expenses, 26% skipped medical care because of financial concerns, and 22% reported that they were unable to cover the cost of their care.

African-American patients were more likely to experience financial toxicity than white patients, and a younger age at diagnosis was associated with higher financial toxicity scores, whereas marriage was associated with a lower risk for financial toxicity.

The researchers urge the use of multidisciplinary support services, such as financial counselors, social workers, and insurance company representatives, to address patient financial toxicity during cancer treatment. They also point out the need for more education for physicians on the actual cost of care, as well as for patient advocacy and increased transparency around the cost of treatment.