Financial Toxicity May Lead to Cost-Coping Strategies in Gynecologic Cancer

Use of economic coping mechanisms were associated with scoring 26 or lower on the COST analysis, or Comprehensive Score for Financial Toxicity, in patients being treated for gynecologic cancers.

An analysis of financial toxicity published in the International Journal of Gynecologic Cancer indicated that health outcomes in patients with gynecologic cancer may be associated with economic cost-coping strategies.

As such, severe financial toxicity was found to be associated with the high-risk behavioral cost-coping mechanism of medication non-compliance (adjusted risk ration (aRR) of 4.6 (95% CI, 1.2-18.1).

“Financial toxicity at moderate and severe levels was associated with utilization of cost-coping strategies, particularly economic behavior changes, whereas medication non-compliance was only significantly used by those with severe financial toxicity. These findings suggest that cost-coping strategies vary based on the financial toxicity level and can be used in clinical practice to proactively direct financial resources and counseling to patients,” said investigators of the study.

Investigators examined patients from Beth Israel Deaconess Medical Center (BIDMC) in Boston (n = 240) and the University of Alabama at Birmingham (UAB; n = 121) for their analysis. Of these, 308 patients met the inclusion criteria. There was no significant difference between patients treated at the 2 centers (P = .17).

The 11-item Comprehensive Score for Financial Toxicity (COST) was used to determine financial toxicity with a range from 0 to 44. Investigators used 3 levels to determine toxicity: scores greater than 26 had no or mild toxicity; scores between 14 and 25 had moderate toxicity; and scores between 0 and 13 had severe toxicity. Patients who scored lower showed more severe financial toxicity.

It was found that patients from BIDMC had a higher median COST score of 28 than those from UAB at 24 (P = .002).

Patient characteristics at UAB compared with BIDMC differed slightly, including a higher proportion of Black respondents (27% vs 5%; P < .001) and a lower proportion of Hispanic (0% versus 4%) and White respondents (71% versus 84%; P < .001).

Median household income differed between the centers, with an average income at BIDMC of $87,000 per year vs $40,00 per year at UAB. Differences in education were also found, with 63% of patients at BIDMC having bachelor’s degrees compared with 33% of patients at UAB. It was also found that 46% of respondents at BIDMC versus 27% at UAB were employed, while 46% vs 34% were retired (P < .05).

Looking at clinical factors, those at BIDMC were more recently diagnosed compared with UAB (7 months vs 28 months; P<.001).

In the cohort studied, 46 patients (14.9%) had severe financial toxicity whereas 99 (32.1%) had moderate and 163 (52.9%) had mild or no toxicity. Lower age was correlated with more severe financial toxicity. No or mild toxicity was associated with patients aged 56 to 70 years, moderate toxicity for ages 49 to 68, and severe toxicity for ages 50 to 61.

The type of gynecologic cancer was not associated with severe financial toxicity (P = .24), but a shorter time since diagnosis, undergoing surgery, and use of therapy were all associated with financial toxicity (P < .05).

Patients with severe financial toxicity were 4.6 times (95% CI, 1.2-18.1) as likely to report medication non-compliance compared with those with no or mild financial toxicity.

Patients who had moderate (aRR 2.7; 95% Ci, 1.8-4.0) or severe (aRR of 3.6; 95% CI, 2.4-5.4) financial toxicity were significantly more likely to change spending habits as an economic coping strategy. Similarly, moderate (aRR 5.5 ;95% CI, 1.8-16.5) and severe (aRR of 12.7; 95% CI, 4.3-37.1) financial toxicity was also significantly associated with borrowing money.

“Nearly 50% of surveyed patients reported financial toxicity, which approximates or exceeds estimates of financial burden in broader cancer populations. Within our multi-institutional patient cohort, we also confirmed previously described risk factors for financial toxicity including younger age, lower income, insurance status, and need for systemic therapy. While many of these factors are not modifiable, they can be used to identify patients at increased risk for financial toxicity,” concluded investigators.


Esselen KM, Gompers A, Hacker MR, et al. Evaluating meaningful levels of financial toxicity in gynecologic cancers. Int J Gynecol Cancer. 2021;31(6):801-806. doi:10.1136/ijgc-2021-002475