Screening for Financial Toxicity and Health-Related Social Risks in Patients With GI Cancer: Results From a Large Cancer Center.

Abstract

Patients with GI cancers often face significant financial toxicity (FT) and health-related social risks (HRSRs), yet best practices for screening remain unclear. This study aimed to evaluate the prevalence of FT and HRSR and identify associated factors. From June 2022 to August 2023, patients were screened using the Comprehensive Score for Financial Toxicity (COST), patient-reported HRSR (eg, housing, food insecurity), and quality of life (QOL). Multivariate regressions were used to assess predictors of FT and HRSR, adjusting for several variables. Among 8,335 patients with GI cancer, 45% had a COST score of <26, indicating FT. In adjusted linear regression, FT was associated with racial/ethnic minority status (β, 4.20; <i>P</i> < .001), advanced disease (stage III [β, 1.33; <i>P</i> < .001]; IV [β, 1.56; <i>P</i> < .001]), recent treatment (β, 3.23; <i>P</i> < .001), and anal (β, 1.97; <i>P</i> = .003), esophageal (β, 1.66; <i>P</i> = .005), or hepatobiliary cancer (β, 1.05; <i>P</i> = .031). Older age (≥65 years [β, -5.17; <i>P</i> < .001]), higher income ($100,000-$200,000 [β, -1.81; <i>P</i> < .001]; >$200,000 [β, -3.80; <i>P</i> < .001]), and private insurance (β, -1.70; <i>P</i> < .001) were protective. Twenty-eight percent reported at least one HRSR. HRSRs were associated with minority status (odds ratio [OR], 2.14; <i>P</i> < .001), advanced disease (stage III [OR, 1.31; <i>P</i> = .001]; IV [OR, 1.24; <i>P</i> = .010]), recent treatment (OR, 1.20; <i>P</i> = .001), and gastric cancer (OR, 1.25; <i>P</i> = .027). Lower HRSR was associated with older age (OR, 0.59; <i>P</i> < .001), higher income ($100,000-$200,000 [OR, 0.66; <i>P</i> < .001]; >$200,000 [OR, 0.48; <i>P</i> < .001]), and private insurance (OR, 0.64; <i>P</i> < .001). Sex was not a predictor. Worst FT was associated with decreased QOL (β, -0.98; <i>P</i> < .001) and reduced medication adherence (β, 0.11; <i>P</i> < .001). High levels of FT and HRSR were observed in patients with GI cancer. Early intervention to address financial and social burdens may improve both disease and survivorship outcomes.