# Financial toxicity on treatment outcomes in head & neck cancer patients undergoing radiation therapy

## TL;DR

This study shows that financial hardship in head and neck cancer patients undergoing radiation therapy is linked to worse quality of life, more treatment complications, and lower survival rates.

## Contribution

The study identifies financial toxicity as a significant factor affecting treatment outcomes in head and neck cancer patients.

## Key findings

- Lower financial toxicity scores correlated with worse health-related quality of life and more treatment complications.
- Patients with higher financial toxicity had better two-year overall survival rates.
- Financial toxicity was associated with socioeconomic factors like younger age, Black race, and Medicaid insurance.

## Abstract

Financial toxicity, defined as hardship from medical costs, is an emerging concept in healthcare. Here we define financial toxicity in head and neck cancer patients receiving radiation, identify risk factors, and determine associations with HRQoL, treatment morbidity, and survival.

We conducted a prospective study on consecutive patients referred to a tertiary referral center for radiation therapy for head and neck malignancies (July 2021–June 2023). Patients provided consent and were assessed using validated patient-reported outcome measures for financial toxicity (FACIT-COST), HRQoL (EORTC-QLQ-C30), and symptom burden (PRO-CTCAE) before and after radiation therapy. Primary outcomes included two-year overall survival (OS), treatment morbidity (ER visits, hospitalizations, feeding tube placement, missed radiation days), HRQoL, and symptom burden.

Among 74 patients (median age 69), all completed pre-radiation therapy (pre-RT) measures, and 39 completed post-RT measures. Median pre-RT COST was 29 (range: 0–44), with 41.9% scoring ≤25, indicating worse financial toxicity. Lower pre-RT COST scores correlated with younger age, Black race, Medicaid insurance, single or unemployed status, advanced T-stage, and concurrent chemoradiotherapy (p < 0.05). These patients had worse HRQoL, more severe symptoms, increased feeding tube placements, and more ER visits/hospitalizations (p < 0.05). OS was worse with lower pre- (HR = 0.95; 95% CI = 0.91–0.99; p = 0.015) and post-RT COST scores (HR = 0.92; 95% CI = 0.86–0.98; p = 0.012).

Financial toxicity is common in head and neck radiation patients and linked to worse HRQoL, morbidity, and OS. Affected patients had clear socioeconomic risk factors and advanced disease. Further research should explore interventions to improve cancer outcomes.

The online version contains supplementary material available at 10.1186/s13014-025-02749-x.