About 50% of patients with metastatic prostate cancer may experience financial hardship as a result of their treatment, according to a new study published by Joyce et al in The Journal of Urology.
Background
"Our most significant finding may be that patients experience financial toxicity despite their ability to remain compliant with treatment," emphasized lead study author Daniel D. Joyce, MD, a Urologic Oncology fellow in the Department of Urology at the Mayo Clinic. "Simply asking patients whether they are following their suggested treatments is not sufficient to screen for financial toxicity,” he added.
Financial toxicity—harm inflicted on patients as a result of treatment costs—has recently been recognized as an important patient-centered outcome. Previous studies have suggested that up to 50% of cancer survivors may be affected by this toxicity and could consequently be at an increased risk of experiencing adverse treatment outcomes.
"Our findings help in understanding the rates of and risk factors for financial toxicity among patients with advanced prostate cancer, along with the coping mechanisms—including the impact on personal spending—experienced by those reporting higher levels of financial toxicity," explained senior study author Stephen A. Boorjian, MD, the Carl Rosen Professor and Chair of the Department of Urology as well as Director of the Urologic Oncology Fellowship at the Mayo Clinic.
Study Methods and Results
In the new study, investigators asked 281 patients with a median age of 69 years who were undergoing treatment for metastatic prostate cancer to respond to a validated questionnaire concerning financial toxicity over a 3-month period.
The investigators then assessed the rate of financial toxicity and the related patient characteristics and coping strategies among the responders.
Several patient characteristics were associated with higher or lower risks of financial toxicity. Older patients had lower financial toxicity, and each additional year of age was associated with a 25% reduction in risk. For patients who were married or had a non-married partner, financial toxicity risk was nearly four times lower than for those who were unmarried, widowed, or divorced. Additionally, income was a significant factor—where the risk of financial toxicity was nine-times lower for the patients who reported annual incomes of $100,000, compared with those who reported annual incomes under $20,000.
Based on the questionnaire, the investigators classified 79 patients as having high financial toxicity. Overall, 54% of the patients stated that they experienced at least some level of financial hardship related to their cancer treatment. The impact was found to be more profound among patients with high financial toxicity, with 89% of them reporting financial hardship.
The investigators discovered that the patients who experienced high financial toxicity coped in several ways. They were more likely to decrease spending on basic goods and leisure activities, use their savings to pay for medical care, delay filling prescriptions, and borrow money to pay for their care.
"Notably, very few patients reported only partially filling medications or stopping medications altogether [as a result of] cost," the investigators stressed.
More than 50% of the patients who had high financial toxicity also reported difficulty paying their bills and were more likely to have delays in initiating cancer treatment. Patients who had high financial toxicity were also more likely to use financial assistance programs compared with patients who had low toxicity (32% vs 12%).
"Patients are often unable to meet the high treatment initiation costs without some type of financial assistance program or subsidy," the investigators underscored.
Conclusions
"Some patients may be making profound personal sacrifices in order remain adherent with their prostate cancer treatment, which may have a significant impact on the quality of life that we hope to prolong with these treatments. Conversations about these issues are even more crucial given the observed improvement in financial toxicity among patients … who were able to access financial assistance programs," Dr. Joyce highlighted.
The investigators suggested that identifying factors that may mitigate the financial impact of treatments for metastatic prostate cancer may be imperative to combating financial toxicity.
"Such data are crucial to understand how to include financial toxicity in shared decision-making and to guide future interventions designed to reduce financial toxicity in this population," the investigators concluded.
Disclosure: For full disclosures of the study authors, visit auajournals.org.
