ASPO Abstracts
The Cost of Cure: Understanding Financial Toxicity in Head and Neck Cancer Survivors
Category: Financial Hardship Associated with Cancer
Conference Year: 2020
Abstract Body:
Purpose of the Study: To understand head and neck cancer (HNC) survivors’ treatment related financial toxicity
(FT).
Methods: To assess objective out-of-pocket expenses (OOPE), paid claims data were queried for health plan
members with HNC-primary diagnosis codes (n=5,156) who received treatment within a 2-year period. To
evaluate subjective FT, patients seen in our HNC survivorship clinic between Jan 2018–Aug 2018 (n=252) were
offered a survey, the COmprehensive Score for financial Toxicity (COST). This instrument is measured on a
continuous scale (0-44) with lower scores indicating worse FT. Patients with both claims and survey data were
designated as the target population. The relationship between OOPE and subjective FT was examined using
regression models. Additionally, subgroup analysis was performed by type of insurance coverage.
Results: Seventy-one patients met our inclusion criteria (mean age, 64±10yr). Most were male (n=48, 68%), white
(n=65, 92%) and were, on average, 6±6yr since treatment completion. The most common insurance was
Medicare (n=27, 38%). Most had advanced stage III-IV disease (n=50, 70%). Primary disease of the oropharynx
(n=22, 31%) was the most frequent subsite. Multimodal therapy was most common, with 36 (52%) receiving
surgery+adjuvant treatment. Average per-member OOPE were $3,309, with the highest incurred by Medicare
members ($4,264), and the lowest by Medicaid members ($384). An increase in OOPE after acute treatment was
seen overtime, with a rise in 86% when treatment length increased from 1 to 3 years, then 24% from 3 to 5 years.
Mean COST was 25±11 with the worst FT in Medicare members (COST=19). Analysis of predictors of FT differed
by type of insurance plan. Among patients without employer-based insurance, multiple linear regression modeling
showed that OOPE (p=0.038) and years since diagnosis (p=0.028) were significantly associated with worse
subjective FT (COST) when controlling for marital status and stage.
Conclusions: OOPE vary widely across different insurance plans, with a considerable proportion of survivors
reporting high FT. Among survivors without employer-based insurance coverage, OOPE were significantly
associated with worse subjective FT suggesting that they constitute a particularly vulnerable population.
Keywords: Head and neck cancer Survivorship Financial burden Out-of-pocket expenses Patient reported outcomes