Financial toxicity (FT) of targeted oral anticancer medications (TOAMs) in patients with metastatic non-small cell lung cancer (NSCLC): Do TOAMs confer higher rates of FT than parenteral (IV) therapies?

229 Background: FT in cancer patients (pts) has been associated with adverse outcomes including psychological strain, foregoing medical care, and an increased risk of death. There has been limited data to date to describe FT effects specific to pts with NSCLC, or how medications’ routes of administration may impact FT. IV anticancer therapies (ACTs) generally fall under an insurance plan’s medical benefit, while oral therapies may fall under the pharmacy benefit. Given this difference, we investigated whether pts with metastatic NSCLC who receive TOAMs during their treatment course experience different rates of FT than those who receive only IV ACTs. Methods: This was a single institution, IRB approved study which enrolled pts with metastatic NSCLC. Pts diagnosed with a second malignancy (excluding non-melanoma cutaneous malignancies) within the last five years were excluded. FT was assessed using two validated tools to measure FT: the COmprehensive Score for financial Toxicity (COST) and the InCharge Financial Distress/Financial Well-Being Scale (IFDFW). Lower scores indicate higher degrees of FT in both COST and IFDFW. A third exploratory survey section assessed patients’ behavioral changes in response to any experienced FT. All participants were approached in-person to participate in the study due to the sensitive nature of the questions being asked. Results: Pts were enrolled from Mar – Sep 2024. 53 pts expressed interest in joining the study; 7 ultimately declined to consent, and 3 failed to complete the survey. 43 pts consented to participate and completed the study survey (17 TOAM pts, and 26 IV pts). TOAM pts showed higher levels of FT as assessed by both COST (mean 16.7 vs 24.2 in the IV group; 95% CI of difference 1.57-13.49, p = 0.015) and IFDFW (mean 4.1 vs 5.7 the IV group; 95% CI of difference 0.02–3.23, p = 0.048). Total amount of time on anticancer treatments prior to completing the study survey was nearly identical between the two groups (median 385 and 379.5 days on treatment at the time of survey administration for TOAM and IV pts, respectively). Pts insured though Medicaid reported the highest levels of financial toxicity as assessed by both COST and IFDFW. Conclusions: Our study suggests that pts with metastatic NSCLC who receive TOAMs as part of their treatment course experience higher rates of FT than those who receive only IV therapies. The similar amounts of time spent on anticancer treatment between the two groups suggests that total time spent on treatment does not explain this difference. A larger study is planned to validate these findings and to better define subgroups of NSCLC pts at highest risk for FT.