eP303 - The Financial Toxicity of Rectal Cancer: A Retrospective Review

Purpose/Background: A diagnosis of rectal cancer carries with it a significant amount of physical and emotional stress. The financial stress associated with medical bills, travel, lodging and missed work necessary for modern rectal cancer treatment can be substantial. All of these factors can make the diagnosis overwhelming. We conducted a survey based retrospective review of all rectal cancer patients seen within our institution from 2017-2021, with the goal of evaluating the financial impact and toxicity of their rectal cancer treatment.Methods/Interventions: The UT rectal cancer database was queried for all patients who received treatment from 2017-2021. A financial toxicity survey was sent to patients, one was a proprietary survey collecting some basic demographic information, insurance coverage information and the financial burden caused by treatments, travel, childcare and missed work. The patients were not offered financial compensation and participation was completely voluntary. Additional information on patients’ cancer and treatment was collected as surveys were returned.Results/Outcomes: Of the 260 surveys sent, 32 were returned. Of the survey respondents there were 5 stage Is,8 stage IIs, 12 stage IIIs, 2 stage IVs and 3 unknowns at diagnosis. There was no direct correlation found between lower T stages and reported answers of decreased spending on various items. Beginning at T3 there were more responses which reported decreased spending and for those with T4 disease and metastasis. All patients reported decreased spending in at least one category. Travel distance to radiation treatment (average: 23.2 miles), travel distance to chemotherapy (average: 25.1 miles), and travel distance to surgery (average: 49.4 miles) were not linearly correlated with decreased spending. However, those traveling more than 80 miles for surgery did report higher instances of decreased spending. Travel was noted as a financial stressor for 13/32 patients surveyed and financial stress related to travel correlated strongly with mileage traveled over 65 miles.Conclusion/

Discussion: The surveys returned by patients warranted some interesting but also counterintuitive information. Higher T stage at diagnosis was associated with decreased spending on things like food, leisure, clothes and also increased use of savings. Interestingly, mileage traveled did not linearly correlate with decreased spending, until the mileage was over 65 miles. The study here was limited by the size of the study. Although 260 surveys were sent, only 32 were returned. Another factor limiting the study was recall bias, especially in those patients diagnosed in the early years of the study period. New rectal cancer patient are currently enrolling in a prospective study using similar surveys. Despite these limitations, this study succeeds in showing that the financial toxicity of rectal cancer is multi-factorial. There is more work to be done to understand and help alleviate the financial stress for patients.