부산대학교 도서관

Key words financial toxicity; gynecologic cancer; risk analysis Background The cost of cancer care is high and rising. Evidence of increased patient cost burden is prevalent in the medical literature and has been defined as 'financial toxicity,' the financial hardship and financial concerns experienced by patients because of a disease and its related treatments. With targeted therapies and growing out-of-pocket costs, patient financial toxicity is a growing concern among patients with gynecologic cancer. Objective This study aimed to determine the prevalence of financial toxicity and identify its risk factors in patients with gynecologic cancer treated at a large cancer center using objective data. Study Design Using institutional databases, we identified patients with gynecologic cancer treated from January 2016 to December 2018. Patients with a preinvasive disease were excluded. Financial toxicity was defined according to institutionally derived metrics as the presence of [greater than or equal to]1 of the following: [greater than or equal to]2 bills sent to collections, application or granting of a payment plan, settlement, bankruptcy, financial assistance program enrollment, or a finance-related social work visit. Clinical characteristics were gathered using a 2-year look-back from the time of the first financial toxicity event or a randomly selected treatment date for those not experiencing toxicity. Risk factors were assessed using chi-squared tests. All significant variables on univariate analysis were included in the logistic regression model. Results Of the 4655 patients included in the analysis, 1155 (25%) experienced financial toxicity. In the univariate analysis, cervical cancer (35%), stage 3 or 4 disease (24% and 30%, respectively), younger age (35% for age Conclusion Financial toxicity is an increasing problem for patients with gynecologic cancer. Our analysis, using objective measures of financial toxicity, has suggested that demographic factors and healthcare utilization metrics may be used to proactively identify at-risk patients for financial toxicity. Author Affiliation: (a) Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY (b) Strategy and Innovation, Memorial Sloan Kettering Cancer Center, New York, NY (c) Counseling Center, Memorial Sloan Kettering Cancer Center, New York, NY (d) Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY (e) Patient Financial Services, Memorial Sloan Kettering Cancer Center, New York, NY (f) Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY * Corresponding author: Emeline M. Aviki, MD, MBA. Article History: Received 23 September 2021; Revised 6 December 2021; Accepted 8 December 2021 (footnote) E.M.A. and B.L.M.G. are cofirst authors. (footnote) Outside the submitted work, M.M.L. Jr reports personal fees from Johnson & Johnson and Ethicon, Takeda, and Intuitive Surgical, Inc. Furthermore, he reports institutional research funding from Kinetic Concepts/Acelity. N.R.A.R reports grants from Stryker/Novadaq and GRAIL. D.S.C. reports personal fees from Bovie Medical Corporation; Verthermia, Inc (now Apyx Medical Corporation); Biom'Up, and CSurgeries and other grants from Intuitive Surgical, Inc; Doximity, and TransEnterix, Inc. E.L.J reports personal fees from Covidien/Medtronic. The remaining authors report no conflict of interest. (footnote) This study was funded, in part, through the National Institutes of Health/National Cancer Institute Cancer Center Support Grant P30 CA008748. (footnote) Cite this article as: Aviki EM, Manning-Geist BL, Sokolowski SS, et al. Risk factors for financial toxicity in patients with gynecologic cancer. Am J Obstet Gynecol 2022;226:817.e1-9. Byline: Emeline M. Aviki, MD, MBA [avikie@mskcc.org] (a,*), Beryl L. Manning-Geist, MD (a), Stefania S. Sokolowski, MA (b), Tiffanny Newman, PhD (b), Victoria S. Blinder, MD (c), Fumiko Chino, MD (d), Stephanie M. Doyle, MPH (e), Allison Liebhaber, MS (b), Sushmita B. Gordhandas, MD (a), Carol L. Brown, MD (a,f), Vance Broach, MD (a,f), Dennis S. Chi, MD (a,f), Elizabeth L. Jewell, MD (a,f), Mario M. Leitao Jr., MD (a,f), Kara Long Roche, MD (a,f), Jennifer J. Mueller, MD (a,f), Yukio Sonoda, MD (a,f), Oliver Zivanovic, MD (a,f), Ginger J. Gardner, MD (a,f), Nadeem R. Abu-Rustum, MD (a,f)