# Double burden: financial toxicity in patients with advanced soft tissue sarcoma at the start of first-line palliative chemotherapy: baseline data from the HOLISTIC study

## TL;DR

This study shows that patients with advanced soft tissue sarcoma face financial burdens even before starting chemotherapy, with differences between the UK and the Netherlands.

## Contribution

The study is the first to report baseline financial toxicity in advanced soft tissue sarcoma patients starting palliative chemotherapy, comparing UK and NL populations.

## Key findings

- Financial toxicity was higher in UK patients compared to those in the Netherlands.
- Single patients and those with worse global health status were more likely to experience financial toxicity.
- Financial toxicity predictors varied between the UK and the Netherlands.

## Abstract

The HOLISTIC study assessed health-related quality of life (HRQoL) in advanced soft tissue sarcoma (STS) patients receiving first-line palliative chemotherapy. The secondary objective discussed here is to evaluate baseline self-reported financial difficulties and associated sociodemographic factors and global health status (GHS), compare financial toxicity between patients in the United Kingdom (UK) and the Netherlands (NL), and evaluate the consequences of financial toxicity.

This prospective study included 72 UK and 65 NL patients. Financial toxicity was evaluated by the financial difficulties scale of the EORTC QLQ-C30. Associated factors (i.e., country, gender, educational level, relationship status, employment changes, income, age, time since diagnosis, and GHS) were analyzed using descriptive analysis, Chi-square tests, and univariate and multivariate logistic regression.

Median participant age was 62 (range: 27–79) years, and gender distribution was equal. 58% of UK and 48% of NL patients had no income or a monthly income ≤ £/€ 2000 (p = 0.417). Self-reported additional costs for medication (31% vs. 9%, p < 0.001) and parking (75% vs. 41%, p < 0.001) were more prevalent among Dutch than UK patients. Travel expenses were similar: 68% in NL and 66% in UK. Univariate analysis showed an increased risk of financial toxicity in UK patients (40% vs. 22% [NL], p = 0.023), single patients (52% vs. 27% [with partner], p = 0.014), and those with a change in employment status (46% vs. 24% [no change], p = 0.019). In UK patients, multivariate analysis indicated lower odds for financial toxicity for patients with a high income (OR 0.207, p = 0.031) and higher odds for patients with a worse GHS (OR 5.171, p = 0.012), whereas in NL, higher odds were seen for male (OR 13.286, p = 0.027) and single (OR 41.735, p = 0.007) patients.

Financial toxicity was common among advanced STS already at the start of palliative chemotherapy, influenced by factors such as residence country, income, relationship status, gender, and GHS. Timely interventions are needed to address financial challenges in this population.

STS patients at the start of palliative chemotherapy already experience financial toxicity, affecting their quality of life.Financial toxicity scores are higher in the UK than in NL.Financial toxicity is influenced by factors including residence country, income, relationship status, gender, and GHS.Predictors of financial toxicity differ between UK and NL patients.Toxicity scores should include information on the financial burden of advanced STS patients starting palliative chemotherapy.

STS patients at the start of palliative chemotherapy already experience financial toxicity, affecting their quality of life.

Financial toxicity scores are higher in the UK than in NL.

Financial toxicity is influenced by factors including residence country, income, relationship status, gender, and GHS.

Predictors of financial toxicity differ between UK and NL patients.

Toxicity scores should include information on the financial burden of advanced STS patients starting palliative chemotherapy.