Machine learning prediction of financial toxicity in patients with resected lung cancer

Objectives: We aimed to describe financial toxicity (FT) in patients with resected lung cancer and identify risk factors in this population. Summary Background: FT describes the financial burden associated with cancer care and its impact on the quality of survivorship. Few prior studies have examined FT in lung cancer patients. Methods: Patients who underwent lung cancer resection at our institution between January 1st 2016 and December 31st 2021 were surveyed to gather demographic information and evaluate FT using a validated questionnaire. A multivariable model was built to identify risk factors for FT. Results: 1477 patients were contacted, of whom 463 responded (31.3%). Most patients were stage I (n=349, 75.4%) and lobectomy was performed often (n=290, 62.8%). There were 196 patients (42.3%) who experienced FT. Upon multivariable analyses, divorced marital status (Odds Ratio [OR]= 3.658, 95% confidence interval [CI]: 1.180-11.337), household income <$40,000 (OR=2.544, 95% CI: 1.003-6.455), credit score below 739 (OR=2.744, 95% CI 1.326-5.679), clinical stage > I (OR=2.053, 95% CI: 1.088-3.877), and change in work hours or work cessation (all P<0.05) were associated with FT. Coping mechanisms, such as decreased spending on food or clothing and increased use of savings or borrowing money, were more likely to be reported by patients experiencing FT than those who did not (P<0.001). Conclusions: Patients undergoing lung cancer resection often experienced significant financial stress with several identifiable risk factors. FT should be considered early in the care of these patients to alleviate detrimental coping mechanisms and enhance their quality of survivorship.