Session Item

Cancer patients may face increased costs due to the disease or its treatment. Costs may be direct (e.g. expenditures) or indirect (e.g. loss of income). This objective financial burden can cause subjective financial burden or financial toxicity (FT). FT has been linked to suboptimal treatment outcomes. However, its extent is only poorly understood in cancer patients undergoing radiotherapy (RT) in Germany. In an exploratory study, 31% of 100 cancer patients treated with RT in Germany reported FT at the end of their course which was linked to specific risk factors [DOI: 10.1007/s00066-022-01936-z]. The Young DEGRO working group of the German Society of Radiation Oncology (DEGRO) sought to validate these findings.

We conducted a multicenter (11 sites), cross-sectional and confirmatory study (DRKS00028784) using an anonymous survey. Sites recruited simultaneously during a 60-day period starting from 27/06/2022. Eligibility criteria included i.) cancer patient at the end (+/-2d) of RT, ii.) >18 years, iii.) no previous participation, and iv.) understands the questionnaire. The patient-reported questionnaire was based on the previous study. It included socio-demographic data, questions on direct costs and loss of income related to RT, subjective financial burden as surrogate for FT per EORTC QLQ-C30 question 28, and global quality of life per EORTC QLQ-C30. We hypothesised a confirmation of the prevalence of subjective financial burden on the basis of the previous study if the rate would fall into a 95% binomial exact confidence interval of 26.04-36.31%. A previously described ordinal regression model served to confirm reported risk factors of FT. A p-value <.05 was considered statistically significant.

In total, 1075 patients were recruited resulting in a participation rate of 46% (1075/2341 patients). The completion rate of returned questionnaires was 97% (23035/23851 values). Median patient age was 66 years and 49% (529) were female. The most prevalent diagnoses were breast cancer at 26% (279) and prostate cancer at 18% (198). The median monthly net household income range was 1700-2600€ (228). Mean global quality of life was 55 (SD: 22.3). Objective financial burden was reported by 63% (679) of the patients as additional costs and by 27% (290) as loss of income. Subjective financial burden was reported by 41% (438) which exceeded the previous finding (31%) and hypothesised range. It was felt “A little” by 26% (280), “Quite a bit” by 11% (113), and “Very much” by 4% (45). Per multivariate ordinal regression, higher subjective financial burden was significantly associated with lower income, higher direct costs, and higher loss of income which confirmed previous findings in addition to worse global quality of life (Table 1).

The prevalence of FT in cancer patients undergoing RT in Germany was higher than anticipated. As we robustly confirmed risk factors associated with FT, patients at risk may be addressed early for potential support.