Early Financial Toxicity Findings From the Navigator-Assisted Hypofractionation (NAVAH) Program to Aid African-American Breast Cancer Patients

Summary: Financial toxicity (FT) is defined as the objective financial burden and subjective financial distress of patients with cancer. The high treatment-related costs result in the development and exacerbation of health disparities impacting patient quality of life, disproportionately harming historically marginalized populations. Compared to other racial groups, African-Americans have worse treatment outcomes and socioeconomic barriers impacting their experience with standard-of-care treatment, including radiation therapy (RT). Studies have shown the impact of treatment cost-related financial toxicity on treatment delay/abandonment, personal/family wealth, and psychological well-being. As the most common cancer among African-American women, breast cancer represents an optimal milieu to assess the FT of treatment. We report early FT findings among African-American breast cancer patients on an ongoing Phase I clinical trial (ClinicalTrials.gov ID: NCT05978232) assessing patient navigator assistance during RT as part of the Navigator-Assisted Hypofractionation (NAVAH) program. For this trial, African-American breast cancer patients undergoing RT were eligible if age 18+ with pathologically confirmed breast cancer following lumpectomy. As part of the trial, patients were assigned a patient navigator to assist them throughout treatment and post-treatment. The 12-item COmprehensive Score for financial Toxicity-Functional Assessment of Chronic Illness Therapy (COST-FACIT) validated survey instrument was used to measure FT. In COST-FACIT, lower scores are associated with greater FT. FT findings of patients before receipt of RT were amalgamated per COST-FACIT scoring, on a scale of 0 to 44. Values of 26 or higher represent Grade 0 FT (no FT), values between 14 and 25 represent Grade 1 FT (mild FT), values between 1 and 13 represent Grade 2 FT (moderate FT), and values of 0 represent Grade 3 FT (severe FT). Previous studies have shown younger age, lower socioeconomic status, and lack of partnership status to correlate with lower COST-FACIT values, and therefore higher FT. The first 31 enrolled patients having completed the pre-RT COST-FACIT survey were evaluated (range 4.4 - 39). Mild to moderate financial hardship was apparent in 52% of patients. The mean COST-FACIT score was 25 (+/- 10.4), as was the median score. 48% had Grade 0 FT, 29% Grade 1, 23% Grade 2, and 0% Grade 3. The NAVAH study is the first to assess FT amongst African-American patients receiving adjuvant RT for early-stage breast cancer. Our findings indicate that prior to receipt of RT, more than half of participants experienced some degree of meaningful FT. Encouragingly, nearly 50% of patients had not suffered FT prior to receipt of adjuvant RT. Further study as this trial progresses will illuminate the impact of RT on FT, which we expect will enable the development of targeted solutions to alleviate FT in this vulnerable population. Maya Stephens (she/her/hers), MS (Presenting Author) - Medical College of Georgia; Nimisha Kasliwal (she/her/hers), - (Co-Author) - University Hospitals; Ursula J. Burnette (she/her/hers), - (Co-Author) - University Hospitals; Louisa Onyewadume, MD MPH (Co-Author) - University Hospitals; Chesley W Cheatham, MEd MCHES (Co-Author) - University Hospitals; Tamika K. Smith, AAB (Co-Author) - University Hospitals; Corey W Speers, MD PhD (Co-Author) - University Hospitals; Janice A. Lyons, MD (Co-Author) - University Hospitals; Shearwood McClelland III (he/him/his), MD (Co-Author) - University Hospitals