514 Background: Financial toxicity (FT), or the downstream economic effects of cancer, has been well-documented in patients and linked to poorer quality of life. Most analyses of FT have been cross-sectional, and few have specifically examined FT in Black/African American patients or their informal caregivers (i.e., family and friends who provide unpaid assistance). Methods: The team enrolled Black/African American women with non-metastatic breast cancer from a comprehensive cancer center within 8 weeks of diagnosis. Patients referred a caregiver (“your most important support person in dealing with breast cancer”). Patients and caregivers completed separate telephone surveys at baseline, 2 months, 4 months, and 18 months. Patients completed the 12-item COmprehensive Score for Financial Toxicity (COST) tool at each survey; caregivers completed a caregiver version at the 18-month survey only. A latent trajectory model in Mplus examined change in patient FT over time and explored patient and caregiver correlation in FT. We determined the number of participants with COST scores ≤20 (a positive FT screen) at each timepoint and examined correlations between the full COST and an abridged, 2-item version. Results: From January 2021–May 2023, we enrolled 107 patients and 103 caregivers. Mean patient age was 58.5 (SD = 11.2); mean caregiver age was 49.9 (SD = 14.2). Most caregivers (93%) described themselves as Black/African American, were not the patient’s partner (78%), and did not live with the patient (66%). Mean patient COST scores were 24.1 (SD = 10.0) at baseline, 24.0 (SD = 10.2) at 2m; 25.2 (SD = 9.3) at 4m; and 26.6 (SD = 9.7) at 18m. Mean caregiver COST score was 28.7 (SD = 8.0) at 18m. A COST score ≤20 was demonstrated by 26% of patients at baseline, 31% at 2m, 26% at 4m, and 19% 18m, as well as 10% of caregivers at 18m. A modified linear model showed the best fit: When patient COST scores were constrained to be the same at the first two timepoints, there was then a subsequent decline in FT. The significant slope (p = .006) but nonsignificant variance (p = .215) indicated a common trajectory across patients. FT correlation between patients and caregivers was nonsignificant (p = .736). The brief COST had lower rates of missing data and strongly correlated with the full COST; correlations ranged from .79 (patient baseline) to .90 (patient 2m; p < .001 for all). Conclusions: Over one quarter of Black women with breast cancer demonstrated FT near the time of diagnosis. Patients’ FT declined modestly over 18 months, indicating an improving financial situation as most completed active treatment. At 18 months, caregiver FT was low, and patient and caregiver FT were not significantly associated. Future work should examine how caregiver FT may change over time. The 2-item COST is a promising tool for routine FT screening in patients and caregivers.
Thompson et al. (Wed,) studied this question.