Y. Ciftci1, S. N. Radomski1, N. Winicki1, F. M. Johnston1, J. B. Greer1 1Johns Hopkins University School Of Medicine, Department Of Surgery, Baltimore, MD, USA
Introduction:
Financial toxicity (FT) refers to the financial burden of cancer care and can adversely affect patients with cancer by lowering quality of life and increasing risk of morbidity and mortality. Area deprivation index (ADI), a multidimensional ranking of neighborhoods based on socioeconomic factors, may be useful to identify patients at risk of FT in the clinical setting. There are no studies investigating the utility of ADI in identifying financial toxicity risk among patients undergoing cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC).
Methods:
We performed a retrospective cohort study of patients undergoing CRS-HIPEC from 2016-2022 at a single quaternary center. We utilized insurance status, actual out-of-pocket expenditures, and estimated post-subsistence income to determine risk of financial toxicity. Our study cohort was divided into quartiles based on ADI score, with higher scores indicated greater levels of socioeconomic inequality. Quartile 1 corresponded to lower ADI scores (1-25) and quartile 4 to higher ADI scores (76-100). The Kruskal-Wallis test was used to compare continuous variables and χ2 test to compare categorical variables. We also performed a multivariable logistic regression to assess the association between ADI and financial toxicity risk.
Results:
Our final study cohort consisted of 163 patients. The average age was 58 years (SD: 10) and 57.1% (n=93) were female. 51 patients (31.9%) were at risk of FT. Most patients had private insurance (n=116, 71%). 126 patients (77%) had ADI scores below 50, while 37 patients (23%) had ADI scores above 50. A higher proportion of patients with ADI scores above 50 were at risk of financial toxicity compared to patients with ADI scores below 50 (n=15, 41% vs. n = 37, 29%, p=0.06) (Figure 1). Age, sex, PCI score, median out-of-pocket expenditures, and operative time were similar across ADI quartiles. Multivariable logistic regression revealed that patients in ADI quartile 4 (>76) were at significantly higher risk of financial toxicity compared to patients in quartile 1 (OR 5.53, 95% CI 1.28-10.0).
Conclusion:
In patients undergoing CRS-HIPEC, higher ADI scores correspond to a greater risk of financial toxicity compared to patients with lower ADI scores. ADI may be used in the preoperative setting to identify patients at risk of financial toxicity, especially for patients from geographic locations with high ADI scores (>75).
