ESTRO 2023 - Abstract Book

S472

Sunday 14 May 2023

ESTRO 2023

If the treatment plan comparison indicates a difference in NTCP above 5% on the risk of dysphagia or xerostomia, the patient is eligible for the trial. This procedure results in one extra week before treatment start. Purpose 1. Investigate to which extent patients with HNC were evaluated for inclusion in a trial comparing radiotherapy with photons and protons. 2. Explore patient - and physician related barriers to participate in the PT trial as well as the patient perspective regarding treatment in a centralised proton clinic. Patients with larynx- and pharynx cancer referred to curative intended radiotherapy were prospectively registered on a screening log at six Danish radiotherapy clinics. The screening log contains data on the amount of performed and non- performed treatment plan comparisons and reasons for non-performed plans. Study 2 Semi-structured interviews with HNC patients rejecting trial participation and physicians from the six Danish radiotherapy clinics are conducted. The interviews were audio-recorded, transcribed and will be analyzed based on Interpretive Description methodology. 517 (79%) did not proceed to a dose plan comparison and thus the possibility of inclusion in the trial. The reasons were due to clinical barriers (23%), structural barriers (17%) or patients' rejection mainly due to distance to the treatment facility (39%). 136 patients (21%) had a comparative dose plan performed and, 80 of these comparisons showed a potential benefit of PT, leading to trial inclusion. Study 2 During 2022, 19 interviews were conducted. The analysis is ongoing. Ready for presentation at ESTRO 2023. The preliminary findings indicates the following barriers to the PT trial. • Stay home with family nearby • Begin treatment immediately due to active cancer • Treatment effect seems more important to the patient's than late toxcicities • Once trust has been build up in the local clinic, patients prefer to stay here • Uncertainty regarding the randomization procedure and information material • Different ways in which physicians communicate clinical trials • Gatekeeping function in local clinics • Different perspectives on shared decision-making Conclusion The majority (79%) of patients screened for inclusion did not proceed to the treatment plan comparison. A qualitative study are conducted to explore the underlying barriers for trial participation. Patients decide trial participation based on the feelings in the present situation and find it difficult to take future toxicities into account. OC-0590 Financial toxicity in Swiss cancer patients treated with proton therapy B. Bachtiary 1 , L. Grawehr 2 , U. Held 3 , D.C. Weber 1 1 PSI, Center for Proton Therapy, Villigen, Switzerland; 2 University of Zurich, Faculty of Medicine, Zurich, Switzerland; 3 University of Zurich, Department of Biostatistics , Zurich, Switzerland Purpose or Objective Proton therapy (PT) is delivered for certain types of cancer where conventional photon radiotherapy is challenging to apply. In Switzerland, a fixed list of indications has been defined by the Federal Office of Public Health, and compulsory health insurance covers the costs of PT for these indications. However, patients still have additional out-of-pocket expenses, such as travel to the proton center or accommodation during PT. This study investigates the financial toxicity of patients undergoing PT in a high-income country. Materials and Methods Between September 2019 and November 2021, 146 cancer patients living in Switzerland participated in the study, of which 90 (62%) were adult patients and 56 (38%) were caregivers of child cancer patients. For all patients, the costs of proton therapy were fully covered by health insurance. Financial toxicity was assessed using the FACIT Comprehensive Score for Financial Toxicity (COST). The score ranges from 0 to 44, with a lower score indicating low financial well-being. Financial coping strategies were explored using polar questions (yes-no questions). Out-of-pocket costs during PT were recorded in a diary that patients completed weekly Results The median COST Score was 29.85 (IQR, 21.00-36.00) for all patients, 30 (IQR 21.25, 37.85) for adult patients, and 28 (IQR, 20.50, 34.00) for children’s caregivers, respectively. On multivariable analysis of the adult/children cohort, older age (Estimate 0.08, 95% CI [0.01;0.15], p=0.022), higher income (Estimate 8.82, 95% CI [4.59;14.06], p=<0.001), and distance of < 100 km from home to the center (Estimate -3.76, 95% CI [-5.63;-1.9], p=<0.001) were significantly associated with higher COST Scores indicating better financial well-being. The analysis of the adult group alone revealed that single adult patients had significantly better COST scores than those in partnerships (Estimate: -9.16, 95% CI [-14.45;-3.87] p=<0.001). Patients with high COST scores used significantly fewer coping strategies such as, saving on leisure activities (Estimate - 9.94, 95% CI [-12.07;-6.22], p=<0.001), spending savings (Estimate -4, 95% CI [-6.47; -1.53], p=0.002), borrowing money (Estimate -5.79, 95% CI [ -0.96; -1.62], p=0.007), and increased workload (Estimate -5.28, 95% CI [-10.37; -0.21], p=0.041). Materials and Methods Study 1 Results Study 1 From October 2020 to September 2022, 653 patients were screened for inclusion.