Abstract A005: The cause behind the COST – exploring qualitative and quantitative aspects of financial toxicity in women diagnosed with advanced/recurrent endometrial cancer

Abstract Objective: To evaluate the prevalence of financial toxicity in women diagnosed with advanced/recurrent endometrial cancer and describe characteristics and qualitative aspects of financial stressors in this population. Methods: Women diagnosed with advanced/recurrent endometrial cancer at an urban academic center were invited to participate in a mixed-methods study to describe quality-of-life (QOL) and financial toxicity. Participants completed surveys including the EuroQOL-5D-5 (QOL), financial toxicity tool (COmprehensive Score for Financial Toxicity (COST) ) and completed an interview inquiring about financial stressors. Descriptive statistics were performed, and interviews were transcribed and analyzed using Atlas. ti to identify themes. Results: Eighty-four women participated in the study reflecting a 90% response rate. Participants were a median age of 67. 0 years and 6 (7%) self-identified as Hispanic. Most participants self-identified as White (41, 49%), followed by Black (35, 42%), and multiracial (8, 10%). Forty (49%) participants had advanced stage cancer while 42 (52%) had recurrent cancer, with endometrioid adenocarcinoma (41, 50%) represented as the most common histology followed by serous carcinoma (18, 22%), carcinosarcoma (11, 13%), the remaining clear cell carcinoma/mixed/undifferentiated (14, 17%). The median financial toxicity score of the population was 28. 0 (IQR: 21-35) out of 44. 0, with 38. 1% of participants reporting moderate financial toxicity (COST 26) and 8. 3% reporting severe financial toxicity (COST 14). Lower financial toxicity scores (indicating poor financial wellness) were associated with younger age (65yo: 24. 0 vs. 65yo: 32. 0; p0. 01), Black and multiracial participants compared to white participants (Black: 26. 0, multiracial: 16. 5, white: 33. 0; p0. 05), Hispanic ethnicity (13. 5 vs. 30. 0; p0. 001), single marital status (26. 0 vs. 33. 0; p0. 05), and lower education (Less than college: 24. 1 vs. college and above: 30. 0; p0. 05). On multivariate linear regression, financial toxicity scores were associated positively with older age (B= 6. 5, p0. 01) and non-single marital status (B=4. 8, p0. 05) but were negatively associated with Hispanic ethnicity (B= -11. 4, p0. 05). The median QOL score (health utility score) of the population was 0. 80 (IQR: 0. 71- 0. 85) and this score was positively correlated with better financial wellness (higher financial toxicity score) (R= 0. 3, p0. 05). Qualitative analysis of participant interviews found that participants experiencing financial toxicity reported themes of “forced retirement” and “forced work interruptions” (9, 11%) while those with financial wellness praised “quality insurance coverage” (19, 23%). Conclusion: Patients with advanced/recurrent endometrial cancer experience a high rate of financial toxicity. Although limited by sample size, financial toxicity was found to be significantly worse in younger, single, and Hispanic women. Further work to study this at-needs population should be done to identify causes and develop solutions to assist patients with financial stressors. Citation Format: Sarah A. Ackroyd, Gini Fleming, Nada Attia, Cheska Zoleta, Nita K. Lee. The cause behind the COST – exploring qualitative and quantitative aspects of financial toxicity in women diagnosed with advanced/recurrent endometrial cancer abstract. In: Proceedings of the AACR Special Conference on Endometrial Cancer: Transforming Care through Science; 2023 Nov 16-18; Boston, Massachusetts. Philadelphia (PA): AACR; Clin Cancer Res 2024;30 (5Suppl): Abstract nr A005.