Purpose/Objective(s) Radiation Therapy (RT) is generally considered cost effective, but this and other cancer therapies can impact patient financial wellbeing. A multitude of patient, disease, and treatment variables may contribute to financial burden. We aim to define the patient-reported financial burden of cancer treatments over time for a large cohort of patients previously treated with RT at a single institution. Materials/Methods In this cross-sectional cohort study, we sent a survey assessing the financial impact of cancer treatment to 24,834 patients who received curative-intent RT for cancer at a single institution across 4 states between 2013-2022. The 23-item survey utilized modified COST-FACIT questions and qualitative questions to assess financial burden. Patient demographics, disease and treatment characteristics, and insurance details were collected and assessed with univariate ANOVAs as predictors of past financial status as measured by the modified COST-FACIT. If a predictor was significant, Tukey's adjustment was used to conduct pairwise comparisons. Results A total of 2,376 patients (11% response) completed the survey and provided consent. Median age was 62 years, 57% were men, 96% were white, and 80% were married. The most common disease sites were GU (28%), Breast (26%) and H&N (9%). Most (47%) had commercial insurance while 33% had Medicare and 10% Medicare Advantage. A total of 42% reported their illness caused at least some financial hardship. Greater financial burden, as measured by decreasing COST-FACIT, was associated with female sex (p<0.001), non-white race (p<0.001), Hispanic ethnicity (p = 0.009), lower level of education (p<0.001), use of Medicaid (p<0.001), and single status (p<0.001). Notably, RUCA code and distance from treatment facility were not associated with financial hardship. Patients with CNS or anorectal cancers reported the most financial burden, while GU patients reported the least. Peri-treatment hospitalizations and grade 2+ toxicities were associated with increased financial burden (p<0.001). Chemotherapy, surgery, RT, and immunotherapy were reported as one of the greatest contributors to financial difficulties by 28%, 25%, 25%, and 19% of patients who received them, respectively. For patients with recurrence, 41% reported this to be one of the greatest contributors. While 24% of patients reported not feeling at all in control of their financial situation during treatment, this significantly decreased to 9% at the time of survey (mean 5 years later) (p<0.001). Conclusion Many patients experience financial hardship due to their cancer diagnosis and treatment costs. Patient demographics, insurance, diagnosis, and toxicities of treatment were predictors of hardship. Most patients affected regained financial control after treatment. Effective methods to reduce the financial impact of cancer treatment for patients are needed.

Factors not considered in the final CMS RO-APM proposal such as treatment intent, utilization of proton therapy, and fractionation scheme all have significant cost implications and should be accounted for in future national base rate calculations.

The APP led PRC clinic significantly decreased time from referral to consultation for pts requiring urgent palliative RT for painful bone metastases. Further research is underway to determine if the PRC increases referrals, patients treated, patient satisfaction, and the impact on staffing RO.

Concurrent chemoradiation followed by durvalumab has become the standard of care in patients with unresectable, locally advanced NSCLC based on the PACIFIC trial. Real life data of this practice are emerging, but few data are available on outcomes of patients with progression of disease after this treatment.

Nonagenarians tolerate palliative radiotherapy for distant metastases and locally progressive disease with over 70% of all patients surviving at least three months. Despite their age, radiotherapy should continue to be considered as palliative treatment for nonagenarians.