Managing financial toxicity in patients with prostate cancer

Out-of-pocket expenses can be high for urologic patients, depending on the care they are receiving and what their insurance covers.

Kelvin A. Moses, MD, PhD

At the 2021 Society of Urologic Oncology Annual Meeting, Kelvin A. Moses, MD, PhD, FACS, gave a presentation on how clinicians can reduce these expenses for their patients, whether it be providing resources, patient counseling, or offering multiple treatment options.¹ Moses is an associate professor of urology and fellowship director of urologic oncology at the Vanderbilt University Medical Center in Nashville, Tennessee.

You discussed the topic "financial and toxicity considerations when managing advanced Prostate Cancer" at the 2021 SUO annual meeting. Could you summarize some of the key points from your talk?

The 2 major points that we wanted to focus on were: 1- We have a lot of medications that are available for men with advanced prostate cancer, but they all come with side effects, some of them unique to the treatment, some of them that men on androgen deprivation experience in general. And so, we want clinicians to be aware of the symptoms that men have, like fatigue, hot flash, depression, [and] weakness, and also (be able to) employ some strategies to improve men's quality of life while they're on these therapies; 2- The other point was that these drugs, many of which have been developed since about 2010, are actually quite expensive. Even for insured patients, there may be a large out-of-pocket cost. Clinicians need to be aware of what patients are having to pay out of pocket, how (that cost) can impact their overall quality of life, how it can impact their ability to pay for other necessities in life, and that we really need to advocate on a more systemic level about how [we can] decrease costs for patients with advanced prostate cancer.

What are some strategies clinicians can employ to mitigate financial toxicity in advanced prostate cancer care?

There's a few things we can do. One of the things we have at Vanderbilt, which is a great luxury, is a specialty pharmacy. The pharmacists who deal with the drugs that we prescribe are very savvy in dealing with insurance companies [and] requesting [funding] from foundations to help cover medication. Many times, we can even get 30-day coverage for patients to bridge them, especially if they're starting a new drug.

The other thing, again, is for the clinicians to be aware. And so, ask the questions: "Can you afford this?" We need to know how much a particular drug may be out of pocket. And then lastly, whenever possible, [we should try] to utilize generic medications. Because a lot of these have come out since 2010, not many of them are generic. But as they do transition to that point, we want to make sure that if it is an efficacious medicine, that patient [should] consider using a generic formulation.

What is the outlook in this area? Are cheaper/generic treatments coming down the pipeline?

Slowly, but surely. Most pharmaceutical companies will obtain a 10-year patent on particular drugs. One of the things that companies can do is re-purpose or re-label the drug so that they can extend or renew the patent or trademark. As the drugs become approved by either the [National Comprehensive Cancer Network] or FDA and then used for a long period of time, if they become the standard of care, you can reduce some of the cost as well.

What resources are available for patients who cannot afford their treatment?

There are several foundations that do provide funding assistance for medications. I happen to work with an organization called ZEROTM - The End of Prostate Cancer."² They have a website where men can investigate some resources available. Some of the drug companies have programs specific to their medication. You may have even seen in commercials, "If you cannot afford your medication, we may be able to help." And so, sometimes it's direct funding and that, again, is where our specialty pharmacy comes into play because they can contact these companies and assist. For uninsured patients, it is challenging. And the ability to get quality, high-level care can be difficult, but there are resources from not only the Affordable Care Act, but Medicare and Medicaid, depending on how old patients are. And then, [there are] supplemental coverages that are available. Sometimes it takes a little bit of work on the clinician, the patient, and the pharmacy side, but with a combined approach, a lot of times we can reduce out-of-pocket expenses.

References

1. Moses KA. Financial and toxicity considerations when managing advanced prostate cancer. Lecture presented at: 2021 Society of Urologic Oncology Annual Meeting; December 3, 2021; Orlando, Florida

2. ZERO - The End of Prostate Cancer. Zero Cancer. Accessed December 9, 2021. https://zerocancer.org/