2320 - Financial Distress Does Not Increase after Radiation Therapy: Analysis of Change in COST Score before and after Radiation Therapy

Purpose/Objective(s): Financial distress affects cancer patients’ treatment adherence, quality of life, and outcomes. More than half of cancer patients require radiation therapy (RT). We assessed change in financial distress after RT.

Materials/Methods: Patients were identified from a single institution patient reported outcomes database 12/2021 through 12/2024. Patient demographics, cancer characteristics and treatment were abstracted from chart records. Financial distress was measured using the validated COST instrument, with lower score (0-30) indicating greater financial distress. Patients who indicate significant distress were referred for social work or financial counseling. COST was collected in all patients seen for simulation (baseline) and subsequently in patients presenting for follow-up in January and July of each calendar year (follow-up). Patients were included if they completed baseline and at least 1 follow-up survey. Minimally important difference for COST was defined as 0.5 standard deviation at baseline, 5 points. Paired comparison of COST score was performed using t-test. Univariable and multivariable logistic regression was used to assess factors associated with change in COST after radiation. Statistics were performed using data management and decision management software.

Results: We identified 155 patients. Median time from end of radiation to follow-up was 3.9 months. Median age was 65.4 years. This is a mixed population of 83% White race, 58% male, 49% with Medicare insurance, and 30.3% patients were treated for metastatic cancer. Radiation modalities were 50.3% intensity-modulated RT, 25.8% stereotactic body radiation, 10.3% proton beam, 6.5% 2D/3D, 4.5% radiosurgery, and 2.6% brachytherapy. Median travel distance was 20.8 miles. Travel time was < 30 minutes in 43.2%, 30-60 min in 31.6% and > 60 min in 25.2%. The median COST score was 28 at baseline and increased to 31 at follow-up (p < 0.01), indicating less financial distress. At follow up, 31% of patients had lower COST score with 13% having a MID lower COST, while 60% had a higher COST score and 30% had a MID higher COST. On univariable analysis, only greater travel time was associated with a MID improvement in COST. We did not identify any factors associated with MID decreased COST score.

Conclusion: Most patients experienced stable or improved COST scores at follow-up after radiation therapy indicating decreased financial distress, with almost a third having a MID improvement. Our results suggest that appropriate financial counseling may alleviate financial distress in patients treated with radiation therapy.