2160P - Sociodemographic disparities associated with financial toxicity in stage IV non-small cell lung cancer survivors

Background

The dawn of immunotherapies and tyrosine kinase inhibitors (TKI) for patients with metastatic non-small cell lung cancer (NSCLC) has brought about improved survival. As a consequence, there is now a rapidly growing population of lung cancer survivors (LCS), even in the metastatic setting. Little is known about patient reported outcomes such as financial toxicity during the survivorship period. We evaluated sociodemographic and clinical factors in LCS with metastatic disease at the time of diagnosis and whether these factors are associated with financial toxicity (FT) in a survivorship period.

Methods

We performed a survey study of 176 patients with stage IV NSCLC at diagnosis from December 2020 to March 2023. Surveys with 80% or more of self-reported demographic data completed and 100% of COST tool, a validated 11-part Likert-scale-based questionnaire measuring FT, were analyzed. Final analysis included 129 surveys. Descriptive statistics were used to categorize sociodemographic and clinical features of participants. The Kruskal-Wallis one-way analysis of variance was used to identify sociodemographic or clinical factors associated with FT.

Results

Females were significantly more likely to have completed survey data (p=0.0057). 56% of participants were female, 50% were above the age of sixty-five years, 74% Caucasian, 54% current/former smokers and 91% had an ECOG 0-1. Sixty percent were more than 2 years since diagnosis, 81% on active systemic therapy at the time of the survey, 48% received immunotherapy, and 60% received targeted therapies. Additionally, 76% had private insurance, 86% employed or retired, 20% had a change in employment after the diagnosis, 60% reported annual household income >$75,000 and 82% reported some college level or higher education. We identified that lower household income (p=0.001), unemployment status (p=0.02), and lower education levels (p=0.005) were significantly associated with worsened FT.

Conclusions

Sociodemographic factors are associated with disparities in financial toxicity in LCS with metastatic disease. Future work to identify high-risk populations and potential interventions, such as financial counseling, may improve disparities in patient reported outcomes.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

M.L. Hsu: Financial Interests, Personal, Advisory Board: Regeneron. J. Feliciano: Financial Interests, Personal, Advisory Board, one time advisory board: Genentech, Takeda; Financial Interests, Personal, Advisory Board, one time advisory groups, and one time advisory board leader: AstraZeneca; Financial Interests, Personal, Other, consultant: Merck; Financial Interests, Personal, Advisory Board, one time consultant: Bristol Myers Squibb; Financial Interests, Personal, Advisory Board, Advisory Board member to address disparities in clinical trials: Eli Lilly; Financial Interests, Personal, Advisory Board, advisory board group: Coherus; Financial Interests, Institutional, Local PI, Local PI support for clinical trial: Bristol Myers Squibb; Financial Interests, Institutional, Funding, Research support for health outcomes research project in delays in diagnosis for NSCLC: AstraZeneca; Financial Interests, Institutional, Funding, Research Support for NSCLC survivorship survey of needs - health outcomes research group: AstraZeneca; Financial Interests, Institutional, Research Grant, Co-primary investigator for research grant awarded to Northwestern University and Johns Hopkins for care delivery project in patients with targetable mutations in lung cancer: Pfizer. All other authors have declared no conflicts of interest.