Financial Toxicity in Patients with Cholangiocarcinoma

Data related to health-related quality of life (QOL), including financial toxicity, for patients with cholangiocarcinoma (CCA) who are receiving targeted therapies are limited. Jessica M. Keilson, MD, Winship Cancer Institute, Emory University, Atlanta, GA, and colleagues, in association with the Cholangiocarcinoma Foundation (CCF), conducted a patient-reported health-related QOL study to gain insight into the effect of physical, psychosocial, and financial challenges on patients with CCA. Dr Keilson presented the results at the 2022 ASCO GI Cancers Symposium.

Through the CCF, patients with CCA completed 2 validated QOL surveys—the FACT (Functional Assessment of Cancer Therapy)-Hepatobiliary and the COST (Comprehensive Score for Financial Toxicity) surveys. Subscales included physical well-being, social well-being, emotional well-being, functional well-being, hepatobiliary cancer subscale, financial toxicity scale, and composite FACT scores of these subscales were calculated according to the Manual of Functional Assessment of Chronic Illness Therapy.

A total of 208 patients completed the surveys. Of these, 156 (75%) patients had intrahepatic CCA, 52 (25%) patients had extrahepatic CCA, 96 patients had early-stage disease, 70 had locally advanced disease, and 42 patients had metastatic CCA. Of the 119 (57%) patients with CCA who underwent resection, 56 (48%) had disease recurrence. Overall, 45 (22%) patients enrolled in a clinical trial, 167 (80%) patients had molecular profiling, and 48 (29%) patients received targeted therapy.

Based on the domains of physical, social, emotional, and functional well-being, the QOL scores were similar in patients enrolled in a clinical trial and patients who were not enrolled; however, the patients enrolled in a clinical trial reported higher financial burden (effect size, 0.33; P = .05). Similarly, patients who received targeted therapy reported similar QOL but higher financial toxicity than patients who did not receive targeted therapy (effect size, 0.43; P = .01).

Dr Keilson and colleagues concluded that based on these data, clinical trial enrollment and targeted therapies do not affect a patient’s physical, emotional, social, or functional well-being; however, these strategies are associated with an increased financial burden on patients with CCA. This is because although the therapies used in clinical trials are not paid by the patient, the majority of patients with CCA are enrolled in clinical trials in late disease stage, when they have already accumulated significant costs. The investigators noted that this highlights the need to increase access to clinical trials and personal therapies for patients with CCA to remove financial barriers.

Source: Keilson JM, Lindsey S, Bachini M, et al. Patient report outcomes: financial toxicity in cholangiocarcinoma. Abstract 394.