Financial Toxicity of Oral Chemotherapy in Patients with Primary Brain Tumors

Cancer treatment costs continue to rise with the development of new agents. Financial toxicity is defined as the quantifiable costs associated with cancer and cancer treatment in addition to the patient’s associated distress. This study's rationale is to better understand the financial burden of oral chemotherapies from the perspective of patients with primary brain tumors. After one cycle of oral chemotherapy, we requested patients to complete the Financial Toxicity-Functional Assessment of Chronic Illness Therapy (COST-FACIT) survey and additional questions relevant to insurance and cost. We summarized responses with descriptive statistics within strata defined by on-label or off-label oral therapy. Sixty surveys were completed, with most patients (n = 53, 88%) receiving on-label therapy; only 7 patients (12%) received off-label oral agents. The mean overall financial toxicity score was 23.1 (SD=11.3). When asked if their provider discussed treatment cost before initiation, 21 patients (35%) stated that they did, and 39 patients (65%) said they did not discuss cost or did not recall. However, in the off-label cohort, all seven patients stated that their provider discussed the cost before prescribing. Most patients (70%) had co-pays. Nine (17%) in the on-label group and 3 (43%) in the off-label group had chemotherapy-associated costs that negatively affected their quality of life. A higher percentage of financial distress occurred in the off-label group. Discussing medication costs with patients is an essential part of chemotherapy initiation and may mitigate undue psychosocial and financial distress.