Financial toxicities in patients receiving systemic therapy for brain tumors: A cross-sectional study

Background: Apart from disease management and the toxicities of systemic therapy, financial burden is an additional liability in patients with brain tumors receiving systemic therapy. However, currently, there is a paucity of data on the financial toxicities incurred by these patients. Objectives: In this study, we aimed to assess the perceived financial toxicity and the quality of life (QOL) of patients with brain tumors receiving systemic therapy and to evaluate the factors affecting it. Materials and Methods: This single-center, cross-sectional study was conducted in the Department of Medical Oncology at the Tata Memorial Hospital in Mumbai, India, between January 2019 and March 2019. The financial toxicity scores (FTSs) were captured at a single visit from the patients with primary brain tumors with or without recurrence who visited the Neuro Medical Oncology Outpatient Department. The Comprehensive Score for Financial Toxicity-Functional Assessment of Chronic Illness Therapy and Functional Assessment of Cancer Therapy-Brain (FACT-Br) questionnaires were used to collect data on the FTS and QOL, respectively. Pearson correlation coefficient was used to determine the correlation between FTS and the various domains of QOL. Multiple linear regression was used to determine the factors that influence FTS, and P < 0.05 was considered statistically significant. Results: A total of 147 patients were included in the study; the median age of the cohort was 38 years (range, 16–67). Of them, 102 (67.5%) were men and 48 (32.5%) were women. The median monthly income was ₹7000 ($92.75). The median FTS was 13 (interquartile range [IQR], 6–21). The associated risk factors for financial toxicity were age (beta = 0.242,P = 0.001), category under which the patient availed treatment – private (regular cost) or general (discounted cost) (beta = 0.398, P < 0.001), and disease status (beta = −0.151,P = 0.043). The median FACT-General score, FACT-Br Trial Outcome Index score, and FACT-Br Total score were 77.2 (IQR, 64-91.7), 92.89 (IQR, 73.16–107), and 131.5 (IQR, 107.33–150.9), respectively, and were significantly associated with FTS ( P < 0.001). Conclusions: Financial distress was found to be severe in patients with brain tumors receiving systemic therapy. The age, payment category under which the patients availed treatment, and the disease status were found to be contributory factors. These, along with the QOL, were significantly associated with FTS.