79 “I’m at the Mercy of the Price of Food”: The Impact of Inflation on Financial Toxicity in Cancer Immunotherapy Patients

Faculty Mentor: Djin Tay (Nursing, University of Utah)

Immunotherapy treatments have become the standard of care in the treatment of advanced solid cancers including lung cancer and head and neck cancers. Financial toxicity is well documented in cancer immunotherapy patients due to their high cost and the need for many cancer patients to continue on them long-term, even until the end-of-life. Immunotherapy patients’ financial toxicity may be exacerbated by historic inflation in the past two years that has dramatically increased the cost of everyday items such as food and gas. No studies have yet examined the additional impact of recent inflation on cancer-related financial toxicity. As such, this study evaluated the additional impact of inflation on financial toxicity in cancer patients undergoing immunotherapy and their caregivers. Patient-caregiver dyads were recruited from the lung and head and neck cancer clinics at the Huntsman Cancer Institute. Eligible patients, who were 18 years of age or older, had advanced cancers and had received or were receiving immune checkpoint inhibitors, and their caregivers were recruited from the Total Cancer Care caregiver registry. Audio-recorded semi-structured interviews exploring broad areas of unmet need were conducted at baseline and at 6 months. Two researchers qualitatively coded transcriptions of interviews with a focus on financial toxicity by applying deductive codes based on Jones et al. (2020) Model of Financial burden After Cancer Diagnosis in NVIVO R1. Nineteen patient- caregiver dyads were recruited. Patients were 41-81 years old. Most were treated with Pembrolizumab, White and Non-Hispanic, and insured through Medicare or private insurance. The most commonly applied codes were a participant’s receipt of support from the cancer center, insurance or cancer support organizations (n=37), dissatisfaction with their financial situation (23 counts), financial stress related to medical costs (21 counts), and financial stress from non- medical costs (16 counts). Financial struggle was evident among those most impacted. . Inflation impacted psychological burdens associated with non-medical financial burden, with the rising cost of gas, housing, and food presenting significant challenges. Younger dyads, particularly those without Medicare, were observed to be more affected by financial toxicity, with lifestyle trade-offs and uncertainty about their future commonly identified. These findings have implications for financial toxicity as an unmet supportive care need of cancer patients and their families during this period of inflation.