Financial Toxicity in Patients with Resected Esophageal Cancer

Abstract Background Esophagectomy for esophageal cancer is associated with significant morbidity and can result in financial hardship, yet this aspect of survivorship remains understudied. This study evaluated the prevalence and risk factors of financial toxicity (FT) among patients following esophagectomy. Methods Patients who underwent esophagectomy between January 2016 and September 2022 were surveyed about demographic, financial, and employment history. Financial toxicity was measured by using the validated COST survey. Multivariate analyses identified predictors of FT. Results Of 370 patients contacted, 159 (43%) completed the survey. Median age was 65.3 years; 82.4% were male. Following therapy, 44.7% reported decreased work hours or stopped working entirely. Insurance was employer-based for 50.3%, while 40.6% had Medicare. Financial toxicity was reported by 37.1%. Risk factors included larger household size (odds ratio 2.3), low credit score (odds ratio 13.2), while high income and active retirement were protective. Conclusions More than a third of esophagectomy patients were found to have FT. Those with poor baseline financial health or disrupted employment were most vulnerable and may benefit from early financial counseling and support interventions.