Financial toxicity in patients with newly diagnosed pancreatic cancer: A prospective cohort study.

29 Background: Financial toxicity (FT) refers to the financial strain and distress experienced by patients due to the costs associated with cancer care. Patients with pancreatic ductal adenocarcinoma (PDA) experience unique challenges including limited treatment options, aggressive disease progression, complex multidisciplinary care needs and an overall limited prognosis. The aim of this preliminary analysis was to measure FT in patients newly diagnosed with PDA and determine factors associated FT. Methods: In this prospective cohort study, patients with newly diagnosed PDA prior to treatment initiation were enrolled through a pancreatic multi-disciplinary clinic at a single institution. The Comprehensive Score for Financial Toxicity (COST), a validated instrument for measuring FT, was used to measure participant’s baseline FT upon initial clinic visit and at two-month intervals via online survey. Mean baseline COST scores were compared using a two-sided t test for binary variables and an ANOVA test for categorical variables with >2 categories. Demographic information including age, race, educational experience, income and insurance status was also collected by questionnaire. Results: Between July 2021 and March 2023, 63 patients were enrolled of which 45 participants completed the baseline surveys (71% response rate). Patients with higher stage disease experienced higher baseline financial toxicity, with mean COST score 38.0 for resectable disease, 26.9 for borderline resectable disease, 22.1 for unresectable disease and 17.5 for metastatic disease (p = 0.03). Participants enrolled in Medicaid experienced the highest FT (mean COST 16.0), while those enrolled in Medicare reported the lowest FT (mean COST 31.8). Participants having private insurance fell in-between with a mean COST score 22.1. Baseline FT also varied inversely with household income with participants with annual household incomes <$50,000 experiencing the most FT (mean COST = 12.7) and participants with annual household incomes >$200,000 experiencing the least FT (mean COST = 34.6). Conclusions: Patients with more advanced pancreatic cancer not only face a worse prognosis but also experience heightened financial strain even before initiation of therapy, emphasizing the early vulnerability of these individuals both medically and financially. Future analyses will measure FT longitudinally after treatment initiation and measure the association between FT, response to therapy and mortality. [Table: see text]