Predictors of financial toxicity among head and neck cancer patients: A prospective cohort study.

e18361 Background: Treatment of Head and Neck Cancer (HNC) is associated with significant costs and treatment morbidity. The impact of treatment on financial well-being has not been investigated. Methods: Patients with HNC treated at Princess Margaret Cancer Centre, Canada between 2014 and 2018 were enrolled in a longitudinal study from treatment up to 24 months of follow up. Participants completed questionnaires for demographics, out-of-pocket cost during treatment and at 3, 6, 12, 24 months, and the Financial Toxicity Index (FTI) at 12 and 24 months. The FTI is a 14 item, Likert response scale, with summary score out of 14, and higher scores indicating greater toxicity. Preliminary reliability, validity, and responsiveness for the FTI are very good and ongoing. Uni- and multi-variable analyses (UVA, MVA) were performed to identify predictors for FTI score. Results: Among 363 patients enrolled, average age was 61, 76% male, 81% Caucasian, 72% married, 84% living with others, 53% at least college educated, 57% currently unemployed and 59% had stage IV disease. Median pre-treatment household income was $85K, median lost household income was $15K over 12 months following treatment. At least some difficulty paying for food (14%), housing (17%), or medications (11%) was experienced; 13% had to borrow money and 5% had to relocate housing due to financial pressures. Predictors of greater FTI scores on MVA were younger age (p < 0.001), living alone (p = 0.009), and lower baseline household income (p < 0.001). In subgroup analysis of patients with available information, lost household income (p < 0.001) but not out of pocket costs (p = 0.58) was associated with higher FTI score. Conclusions: Financial toxicity is not uncommon in patients with HNC. Younger age, lower baseline income, living alone, and loss of household income are associated with financial toxicity. This should be a priority population for research into improved supportive care and return to work strategies.