Baseline Financial Toxicity and Cost-Coping Mechanisms Among Patients Presenting for Radiation Therapy

AbstractPurpose Financial toxicity (FT) is an increasingly recognized barrier to high-quality cancer care, yet data describing FT at the initiation of radiation therapy across cancer types are limited. We evaluated the prevalence of FT and its associations with demographic factors, clinical characteristics, and cost-coping behaviors among patients starting radiation therapy at a tertiary academic center. Methods Adult patients scheduled to begin radiation therapy completed a pre-treatment survey as part of a prospective longitudinal study. The survey included the 12-item Comprehensive Score for Financial Toxicity (COST) tool, demographic and clinical variables, and cost-coping behaviors. High FT was defined as a COST score ≤22 (top tertile). We used chi-square, Fisher's exact, and Wilcoxon rank-sum tests to compare high and low FT groups and log-binomial regression to estimate risk ratios (RR) for cost-coping behaviors. Results Among 265 respondents, 35% (n=94) had high FT. These patients were younger, and more likely to be unmarried, have lower income and education, and speak a language other than English (all P ≤0.02). Self-reported race/ethnicity, income, type of cancer and receipt of chemotherapy also differed by FT (all P ≤0.001). Compared to patients with low/no FT, those with high FT were more likely to reduce or stop work (21% vs. 7%, P P Conclusion High FT was common at radiation therapy initiation and associated with social determinants of health and clinical factors. It was strongly linked to behaviors that may negatively impact outcomes, highlighting the need for early FT screening and targeted interventions during radiation therapy planning.