Oral Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2023

Financial toxicity among rural cancer survivors in Gippsland, Victoria, Australia (#54)

Eli Ristevski 1 , Michael Leach 2 , Koku Sisay Tamirat 1 , Mahesh Iddawela 3 4 5 6 7
  1. Monash University, School of Rural Health, Warragul, Victoria, Australia
  2. Monash University, School of Rural Health, Bendigo, Victoria, Australia
  3. Gippsland Regional Integrated Cancer Service, Traralgon, Victoria, Australia
  4. Latrobe Regional Hospital, Traralgon, Victoria, Australia
  5. Medical Oncology, Alfred Health, Melbourne, Victoria, Australia
  6. School of Clinical Sciences, Monash University, Melbourne, Victoria, Australia
  7. Monash University, School of Rural Health, Traralgon, VIC, Australia

Aims: To examine the level of and factors associated with financial toxicity (FT) in rural cancer survivors.

Methods: We conducted a facility-based cross-sectional study among cancer survivors who had medical oncology follow-up over 2017-2019 at a regional hospital in Gippsland, Victoria, Australia. Eligible participants had completed curative treatment for lymphoma, breast, prostate or colorectal cancer. Participants self-completed instruments measuring FT (COmprehensive Score for financial Toxicity-Functional Assessment of Chronic Illness Therapy [COST-FACIT]), health-related quality of life (Functional Assessment of Cancer Therapy-General [FACT-G]), distress (NCCN Distress Thermometer) and supportive care needs (NCCN Problem List).  Non-normally distributed COST-FACIT scores were dichotomised at the median (32), for use as an FT outcome in logistic regression.

Results: Overall, 267 cancer survivors were eligible and 208 completed the COST-FACIT. Of 208 participants, most were female (65%), married (54%), had breast cancer (56%), had a concession card (79%) and retired (55%). The mean (standard deviation [SD]) COST-FACIT score was 31.0 (9.7) on a scale of 0-44, where higher scores denote better financial wellbeing. The highest mean item-specific COST-FACIT score of 3.3 (1.1) out of 4 was observed for unconcern about keeping my job while the lowest mean (SD) item-specific COST-FACIT scores of 2.3 (1.5) and 2.3 (1.6) were observed for satisfaction with one’s financial situation and control of financial situation, respectively. Additionally, the overall FACT-G score was positively correlated with COST-FACIT score (r=0.507, p-value<0.001). Family problems (adjusted odds ratio [aOR]=4.63, 95% confidence interval [CI]=1.44-15.59) and non-retired (aOR=3.45, 95% CI=1.08-11.02) were associated with significantly greater FT (i.e. COST-FACIT scores ≤32). Factors unrelated to FT in multivariable logistic regression included age, born overseas, <year 12 education, gender, marital-status, cancer-type and having a carer.

Conclusion: Greater FT was associated with non-retirement status and family problems. Rural cancer survivors have unmet, interrelated financial and supportive care needs.