Financial toxicity prevalent with bladder Ca patients

Financial toxicity is prevalent among patients with bladder cancer, according to findings from a cross-sectional study presented at the American College of Surgeons Clinical Congress in San Francisco.

Distress related to the cost of medical care is worse in the first year after diagnosis regardless of oncologic stage, and is a topic that patients wish to discuss, said Mark Ehlers, MD, urologic surgery resident, University of North Carolina, Chapel Hill.

“There are a lot of issues in today’s health care landscape that can drive financial toxicity, and there is research showing that it can lead to delays in seeking care, lower quality of life, and even increase the risk of mortality if patients declare bankruptcy. Financial toxicity can be measured and is important to recognize and address,” said Dr. Ehlers, who worked on the study with Angela B. Smith, MD, MS, and colleagues.

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Data indicating that bladder cancer is the sixth most commonly diagnosed cancer and the most expensive cancer to treat from diagnosis to death underlie particular interest in measuring financial toxicity in patients with bladder cancer. The research built on a previous study of bladder cancer patients that found approximately 25% reported financial toxicity, Dr. Ehlers said.

The current study was performed in collaboration with the Bladder Cancer Advocacy Network Patient Survey Network (PSN). PSN enrollees were recruited for participation online by asking them to complete a survey which included the COmprehensive Score for financial Toxicity (COST) questionnaire. The survey is a validated tool for measuring financial toxicity, consists of 12 questions, and has a total possible score ranging from 0 to 44-the lower the score, the worse the financial toxicity.

A total of 226 patients filled out the entire questionnaire, and their mean score was 28.4. The patients represented a nationwide cohort with an average age of 68 years. The majority of patients were male (64%), Caucasian (96%), married (83%), lived in an urban setting (87%), and college educated (21%). Mean time since diagnosis was 65 months, 62% of patients had noninvasive disease, 29% had muscle-invasive bladder cancer, 8% had metastatic disease, and 15% had undergone cystectomy.

Because research has yet to identify a cutoff score that represents clinically significant financial toxicity, factors associated with financial toxicity were investigated by comparing COST scores categorized based on various sociodemographic and clinical characteristics. Results from multivariate analysis showed that younger age, lower household income (<$50,000), being currently employed, and having Medicaid or private self-paid insurance were associated with having worse financial toxicity.

The only disease-related characteristic associated with financial toxicity was time since diagnosis. The COST score was significantly lower (worse financial toxicity) among patients who had been diagnosed within the past 1 year compared with those who were longer out from diagnosis. Mean COST scores were not significantly different between patients with metastatic, invasive, and noninvasive disease.

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“A possible limitation of our study is that the respondents largely had non-invasive disease, and so it is unclear whether patients with muscle-invasive bladder cancer who go on to cystectomy will have a different level of financial toxicity than our study group. However, the majority of patients with bladder cancer do have non-invasive disease, and we did find that stage did not predict financial toxicity,” Dr. Ehlers said.

“The fact that we did not find any difference in financial toxicity based on oncologic stage tells us that any patient with bladder cancer may be affected. That is a huge group of people, but the other findings from our study can provide some insight about identifying those at greatest risk.”

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Survey participants were also asked about their interest in discussing costs of care in addition to being informed about disease- and treatment-related issues such as survival and side effects. The results showed that two-thirds of patients were interested in having their physician discuss costs.

“Previous research indicates that financial toxicity discussions are best handled by a financial navigation team. In future studies, we will be investigating how to effectively integrate that service into the clinic,” Dr. Ehlers said.