Financial Toxicity Common in Insured Brazilian Cancer Patients

Key Takeaways

• Among 1,343 privately insured patients with breast, prostate, colorectal, or lung cancer treated in a private oncology network in Rio de Janeiro and São Paulo, 23% reported baseline financial burden, 25% reported financial burden at 6 months, and 16% developed Q28-based financial toxicity.
• Younger age was independently associated with both 6-month financial burden and financial toxicity, while baseline financial burden strongly predicted 6-month financial burden.
• Lower 6-month global health status was observed with financial burden and financial toxicity, while financial toxicity was not independently associated with overall survival after adjustment, and each 10-point higher 6-month global health status was associated with better survival.

In a prospective Brazilian cohort of Q28-based financial difficulty in insured cancer patients, 25% reported financial burden at approximately 6 months and 16% developed new or worsening difficulty over that interval.

Investigators pooled four prospective observational cohorts from Américas Oncologia in Rio de Janeiro and São Paulo, including 56 colorectal, 387 breast, 638 prostate, and 262 lung cancer cases. Questionnaires were completed before treatment initiation and again at approximately 6 months after treatment start. Financial burden at each assessed time point was defined as any EORTC QLQ-C30 item 28 score of 2 to 4, financial toxicity as new or worsening difficulty at 6 months versus baseline, and global health status from items 29 and 30 on a 0-to-100 scale.

Baseline financial burden varied across tumor types, from 19% in prostate cancer to 28% in breast and lung cancer, with colorectal cancer at 21%. In adjusted models, younger age remained the shared independent predictor of both 6-month financial burden and financial toxicity, while baseline financial burden was the dominant predictor of 6-month financial burden (adjusted OR 5.86; 95% CI 4.31–8.01; p<0.001). Mean 6-month global health status was 70.9 with versus 81.1 without financial burden and 71.7 with versus 79.9 without financial toxicity. Each 1-point higher global health status was associated with lower odds of financial burden (adjusted OR 0.98; 95% CI 0.97–0.99; p=0.004), and lower odds of financial toxicity (adjusted OR 0.98; 95% CI 0.97–0.99; p<0.001).

In an exploratory 6-month landmark analysis, financial toxicity was associated with numerically lower unadjusted survival (HR 1.36; 95% CI 0.95–1.93; p=0.089), but that signal did not persist after adjustment for cancer type. After adjustment for cancer type, neither 6-month financial burden nor financial toxicity was independently associated with overall survival (adjusted HRs of 1.00; 95% CI 0.60–1.68; p=0.993 and 0.97; 95% CI 0.54–1.74; p=0.923, respectively), while each 10-point higher 6-month global health status was associated with better survival (HR 0.90; 95% CI 0.84–0.97; p=0.007).

Clinician Questions

How was financial toxicity defined in privately insured Brazilian cancer patients using EORTC QLQ-C30 item 28?

In this study of privately insured Brazilian patients with breast, prostate, colorectal, or lung cancer, financial burden was defined as any EORTC QLQ-C30 item 28 score of 2 to 4 at baseline or 6 months, and financial toxicity was defined as new or worsening financial difficulty at 6 months compared with baseline. Questionnaires were completed before treatment initiation and again at approximately 6 months after treatment start.

How common were financial burden and financial toxicity in the Brazilian private oncology cohort?

Among 1,343 privately insured patients with breast, prostate, colorectal, or lung cancer in the analyzed Brazilian private oncology cohort, 23% reported financial burden at baseline, 25% reported financial burden at 6 months, and 16% developed Q28-based financial toxicity.

Which factors independently predicted 6-month financial burden or financial toxicity in insured cancer patients in Brazil?

In adjusted models that accounted for age, grouped ethnicity, cancer type, and baseline financial burden when applicable, younger age independently predicted both 6-month financial burden and financial toxicity. Baseline financial burden strongly predicted 6-month financial burden.

Was Q28-based financial toxicity associated with overall survival in this Brazilian cancer cohort?

At the 6-month landmark in this Brazilian cohort, Q28-based financial toxicity was associated with numerically lower unadjusted survival, but after adjustment for cancer type, it was not independently associated with overall survival. Each 10-point higher 6-month global health status was associated with improved overall survival.