Financial Toxicity in Pediatric Neurosurgical Oncology

Introduction: Financial toxicity encompasses the negative impact of medical costs on patients. To our knowledge, financial toxicity in pediatric neurosurgical oncology remains unstudied.

Methods: All pediatric neurosurgical cases from 2016 to 2020 performed at Memorial Sloan Kettering Cancer Center were included. Financial toxicity (FT) was defined as patients experiencing: bankruptcy, bills sent to collections, settlement, or timed payment plan, expression of financial concern to social work, or utilization of copay, financial, or social work philanthropy assistance programs. FT was assessed in the 2 years pre- and post- surgical intervention for all patients.

Results: Two hundred and ninety-five surgical procedures across 203 patients were analyzed. The rate of FT in the two years prior to the first neurosurgical procedure was 17% (34/203), and the most common toxicities were financial assistance program (47%), social work philanthropy (29%), and bills sent to collections (24%). The rate of FT for the subset of patients surviving at least 2 years after surgery was 34% (30/87) with the most common toxicities being financial assistance program (33%), collections (33%) and social work philanthropy (27%). The majority of patients who experienced FT had at least one commercial insurance policy (56% for the pre-surgical cohort, 70% for the post-surgical cohort). For all 203 patients, the 2-year cumulative incidence of FT following first neurosurgical procedure was 19% (CI:14%,25%) with those experiencing pre-operative toxicity having a significantly higher two-year cumulative incidence of FT at 62% (95%CI: [43%,76%], p< 0.001) following first neurosurgical procedure. Patients without FT prior to first procedure had a two-year cumulative incidence of FT of 11% (95%CI: [7%,16%], p< 0.001).

Conclusion : FT rates are substantial in the pediatric neurosurgical oncology population. Pre-operative FT influenced post-surgical FT. The most common toxicity was financial assistance program utilization. The majority of patients and families who experienced FT had at least one commercial insurance plan.