Understanding financial toxicity in head and neck cancer survivors

Objectives: (1) Describe financial toxicity (FT) in head and neck cancer (HNC) survivors and assess its association with personal/health characteristics and health-related quality of life (HRQOL); (2) examine financial coping mechanisms (savings/loans); (3) assess relationship between COmprehensive Score for financial Toxicity (COST) and Financial Distress Questionnaire (FDQ). Patients and methods: Cross-sectional survey from January - April 2018 of insured patients at a tertiary multi-disciplinary HNC survivorship clinic who completed primary treatment for squamous cell carcinoma of the oral cavity, oropharynx, or larynx/hypopharynx. Results: Of 104 survivors, 30 (40.5%) demonstrated high FT. Patients with worse FT were more likely (1) not married (COST, 25.33 +/- 1.87 vs. 30.61 +/- 1.34, p = 0.008); (2) of lower education levels (COST, 26.12 +/- 1.47 vs. 34.14 +/- 1.47, p < 0.001); and (3) with larynx/hypopharynx primaries (COST, 22.86 +/- 2.28 vs. 30.27 +/- 1.50 vs. 32.72 +/- 1.98, p = 0.005). Younger age (4.23, 95% CI 2.20 to 6.26, p < 0.001), lower earnings at diagnosis (1.17, 95% CI 0.76 to 1.58, p < 0.001), and loss in earnings (-1.80, 95% CI -2.43 to -1.16, p < 0.001) were associated with worse FT. COST was associated with HRQOL (0.08, p = 0.03). Most survivors (63/102, 60%) reported using savings and/or loans. Worse FT was associated with increased likelihood of using more mechanisms (COST, OR1.06, 95% CI 1.02 to 1.10, p = 0.004). Similar results were found with FDQ. Conclusions: We found differences in FT by primary site, with worst FT in larynx/hypopharynx patients. This finding illuminates potential site-specific factors, e.g. workplace discrimination or inability to return to work, that may contribute to increased risk. FDQ correlates strongly with COST, encouraging further exploration as a clinically-meaningful screening tool.