Assessment of baseline financial toxicity and cost-coping mechanisms for prostate cancer patients within a high-volume CyberKnife center.

14 Background: Many patients with cancer face significant financial burdens. For those undergoing radiation therapy (RT), which often involves daily treatments for more than 5 weeks, advanced technologies like CyberKnife (CK) stereotactic body radiation therapy (SBRT) offer shorter treatment courses and may help alleviate high financial toxicity (FT). We assessed baseline FT and cost-coping strategies in prostate cancer (PC) patients within a broader cancer cohort. Methods: All patients ≥ 18 years undergoing RT for any malignancy were eligible. Patients were asked to complete the survey before the start of RT. The survey included the Comprehensive Score for Financial Toxicity (COST) tool and questions pertaining to demographic and disease characteristics, social determinants of health, employment, race and ethnicity, income, partnership status, loans, savings, education, insurance, and various cost-coping strategies. Lower COST scores indicate higher FT. High FT was defined as COST scores ≤ 22, which was the top tertile; low FT was defined as > 22. Chi-square, Fisher’s exact, and Wilcoxon rank-sum tests were used to compare the high and low FT groups. IRB exemption was granted. Results: Of 305 respondents, we excluded 40 with incomplete COST scores. Of 107 patients with PC, 57% received CK alone, 27% received external beam radiation therapy (EBRT), 14% received CK+EBRT, and 2% received other treatment. 26% of PC patients reported high FT, while 74% reported low FT. In the entire cohort, high FT was associated with clinical factors, such as receipt of chemotherapy, and cancer type (both P ≤ 0.001), with PC patients less likely to have high FT compared to other cancer types. Within the PC cohort, those with high FT were more likely to have dependents, lower education level, and lower household income, (all P ≤ 0.02). PC patients with high FT were more likely to delay or avoid care, medical visits, filling prescriptions, or buying over the counter medications, and more likely to have borrowed money, used savings, or reduced spending on basic goods or on leisure (all P ≤ 0.01). Conclusions: Although patients with PC within this cohort are less likely to experience high FT than those with other cancers, some still face significant FT and adopt cost-coping strategies that may negatively impact treatment adherence and quality of life. Identifying these individuals remains crucial to reduce FT and improve outcomes. When appropriate, reducing radiation sessions, such as through SBRT, may help mitigate FT.