Financial Toxicity Reported by 37% of Surveyed Esophagectomy Survivors

Financial hardship is an understudied aspect of survivorship after esophagectomy for esophageal cancer. Researchers surveyed surviving patients who underwent surgery at one academic institution between January 2016 and September 2022. Of 370 patients contacted, 159 (43%) responded. The primary outcome was financial toxicity, defined as a score below 26 on the validated Comprehensive Score for Financial Toxicity (COST) questionnaire.

Financial toxicity occurred in 59 respondents (37.1%): 49 had mild and 10 had moderate toxicity; none had severe toxicity. In multivariable analysis, larger household size was associated with higher odds of financial toxicity (OR 2.25, CI 1.21–4.18), as was a credit score below 739 (OR 13.18, CI 2.83–61.46). Income above $140,000 (OR 0.11, CI 0.03–0.45) and retirement at surgery (OR 0.08, CI 0.02–0.27) were associated with lower odds. Among respondents with financial toxicity, 88.1% reported reducing spending on food or clothing.

The findings support attention to baseline financial circumstances during surgical care planning and suggest a potential role for early financial counseling. However, the observational design cannot establish causality or demonstrate that counseling improves outcomes. The single-center setting, 43% response rate, and predominantly male and non-Hispanic White sample limit generalizability; the credit-score association also had a wide confidence interval.