The impact of race, education, and employment status on cost-coping strategies and patient reported benefit from interventions to mitigate financial toxicity.

91 Background: As patient financial toxicity increases with the cost of cancer healthcare, patient outcomes and quality of life may be impaired. We sought to evaluate sociodemographic factors associated with use of cost-coping strategies, as well as strategies to mitigate financial toxicity. Methods: We conducted a survey of consecutive patients in an urban outpatient gynecologic cancer clinic waiting room over 2 weeks in August 2019. The survey included patient demographics, disease characteristics, the Comprehensive Score for Financial Toxicity (COST; scored 0-44, lower scores indicate worse outcomes), assessment of cost-coping strategies, and patient-reported anticipated benefit from possible interventions. Patients were categorized by race/ethnicity (non-Hispanic white, Hispanic white, black, Asian, other) and employment and education status. Kruskal-Wallis and Fisher’s exact tests were used to assess differences between groups. Results: Of 101 patients, 75 completed the survey. Most patients were non-Hispanic white (60%), retired (45%), and had at minimum a bachelor’s degree (65%). The median COST score was 32 (range 6-44). For cost-coping strategies, among renters (n=48), black and other race patients compared to white patients more often indicated skipping a rent payment (25% and 50% vs 0%; p<.01). Employed patients compared to retired patients more often indicated reducing leisure spending (58% vs 27%; p=.02). Patients with less than a bachelor’s degree compared to those with a bachelor’s degree or higher more often indicated borrowing money to pay for medical bills (24% vs 6%; p=.04). For proposed interventions to lessen financial toxicity, non-Hispanic white and Asian patients compared to black patients more often indicated they wanted to know the cost of their healthcare upfront (38% and 33% vs 0%; p =.26). Employed patients compared to unemployed and retired patients more often indicated that minimizing copays would be beneficial (36% vs 13% and 12%, p=.05). Patients with less than a bachelor’s degree compared to those with a bachelor’s degree or higher more often indicated that transportation assistance would be helpful (76% vs 24%; p<.01). Conclusions: As the needs of different sociodemographic groups vary, so do their cost-coping strategies and preferred interventions to ameliorate financial toxicity. Varying patient needs should be considered when developing interventions to mitigate financial toxicity. Next steps should assess the benefit of targeted interventions on coping strategies in specific sociodemographic groups.