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Predictors of Financial Toxicity Risk Among Patients Undergoing Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy (CRS–HIPEC)

  • Peritoneal Surface Malignancy
  • Published:
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Abstract

Background

Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS–HIPEC) is the preferred treatment for select patients with peritoneal malignancies. However, the procedure is resource intensive and costly. This study aimed to determine the risk of financial toxicity for patients undergoing CRS–HIPEC.

Patients and Methods

We performed a retrospective cohort study of patients undergoing CRS–HIPEC at a single institution from 2016 to 2022. We utilized insurance status, out-of-pocket expenditures, and estimated post-subsistence income to determine risk of financial toxicity. A multivariable logistic regression was used to determine risk factors for financial toxicity.

Results

Our final study cohort consisted of 163 patients. Average age was 58 [standard deviation 10] years, and 52.8% (n = 86) were male. A total of 52 patients (31.9%) were at risk of financial toxicity. A total of 36 patients (22.1%) were from the lower income quartiles (first or second) and 127 patients (77.9%) were from the higher income quartiles (third or fourth). A total of 47 patients (29%) were insured by Medicare, and 116 patients (71%) had private insurance. The median out-of-pocket expenditure across the study cohort was $3500, with a median of $5000 ($3341–$7350) for the at-risk group and $3341 ($2500–$4022) for the not at-risk group (p < 0.001). Risk factors for financial toxicity included high out-of-pocket expenditures and a lower income quartile.

Conclusions

An estimated one-third of patients undergoing CRS–HIPEC at our institution were at risk for financial toxicity. Several preoperative factors were associated with an increased risk and could be utilized to identify patients who might benefit from interventions.

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Acknowledgement

The authors would like to acknowledge the following individuals who aided in data collection: Isabella Florissi, Nolan Winicki, and Benjamin Shou. The authors would also like to acknowledge Nolan Winicki for assistance with statistical analysis. Shannon N. Radomski received financial support from National Cancer Institute (NCI) grant 5T32CA126607-12 and the American College of Surgeons Resident Research Scholarship.

Funding

Shannon N. Radomski received financial support from National Cancer Institute (NCI) Grant 5T32CA126607-12 and the American College of Surgeons Resident Research Scholarship.

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Authors and Affiliations

  1. Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Yusuf Ciftci BS, Shannon N. Radomski MD, Fabian M. Johnston MD, MHS & Jonathan B. Greer MD

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Ciftci, Y., Radomski, S.N., Johnston, F.M. et al. Predictors of Financial Toxicity Risk Among Patients Undergoing Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy (CRS–HIPEC). Ann Surg Oncol 31, 1980–1989 (2024). https://doi.org/10.1245/s10434-023-14577-y

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