Study provides insight into the financial impact of treatment for metastatic prostate cancer

A recent survey of patients with advanced prostate cancer showed that 54% experienced some level of financial toxicity related to the cost of their cancer treatment.^1,2

Participants in the study were given a 22-question survey that included questions on demographics, financial toxicity, and coping strategies.

The findings, published in the Journal of Urology, provide insight into the characteristics associated with lower financial toxicity and assess the effect of high financial toxicity on those seeking care.

"Our most significant finding may be that patients experience financial toxicity despite their ability to remain compliant with treatment. Simply asking patients whether they are following their suggested treatments is not sufficient to screen for financial toxicity,” said lead author Daniel D. Joyce, MD, in a news release on the findings.² Joyce is a urologic oncology fellow at Mayo Clinic in Rochester, Minnesota.

Participants in the study were given a 22-question survey that included questions on demographics, financial toxicity, and coping strategies. In total, 281 patients completed the survey and met the study inclusion criteria of being 18 years of age and having received a diagnosis of metastatic prostate cancer (to either lymph nodes, bone, or visceral organs).

At the time of survey administration, treatments included androgen deprivation therapy (ADT) alone (n = 190, 77%), novel hormonal therapies (29%), infusion therapies (n = 38, 15%), immuno-oncology agents (n = 13, 5.3%), and multiple non-ADT synchronous treatments (n = 17, 6.9%). Median treatment duration was 13 months (IQR: 5-36) among all respondents. High financial toxicity was defined as being a COST-FACIT score of 24 or less.

Overall, 54% of patients reported experiencing some level of financial toxicity from treatment. High financial toxicity related to cancer treatment was seen among 79 patients, of which 89% reported experiencing some level of financial hardship related to treatment. In regard to specific treatments, more patients with high financial toxicity had received infusion therapies compared with patients with low financial toxicity (20% vs 5.3%, P < .001).

Participants with lower financial toxicity were more likely to be older (estimate: 0.36, 95%CI: 0.21-0.52), apply for patient assistance programs (estimate: 4.42, 95%CI: 1.72-7.11), and have an annual income of $100,000 or more (estimate: 7.81, 95%CI: 0.97, 14.66), according to multivariable analysis. For patients with annual incomes over $100,000, the risk of financial toxicity was 9 times lower compared with those with annual incomes under $20,000.

Patients with high financial toxicity were more likely to decrease spending on basic goods (35% vs 2.5%, P < .001) and leisure activities (59% vs 15%, P > .001) to help afford treatment compared with those without high financial toxicity. Further, 62% of those with high financial toxicity reported having to use savings to pay for their treatment, compared with only 17% among those who did not have high financial toxicity (P < .001).

"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 in our study who were able to access financial assistance programs,” Joyce added.

Additional findings revealed that patients were split on whether or not physicians should consider costs when providing treatment, with 41% saying “definitely not” and 40% saying that cost should be given some consideration.

The authors wrote, “Ultimately, our findings suggest that additional investigation is warranted to understand how physicians can (or should) effectively and efficiently consider financial toxicity in the context of shared decision-making regarding treatment.”

References

1. Joyce DD, Schulte PJ, Kwon ED, et al. Coping mechanisms for financial toxicity among patients with metastatic prostate cancer: A survey-based assessment. J Urol. Published online July 7, 2023. Accessed July 10, 2023. doi:10.1097/JU.0000000000003506

2. Prostate cancer patients face financial toxicity: Who is affected and how do they cope? News release. Wolters Kluwer Health: Lippincott. July 7, 2023. Accessed July 10, 2023. https://www.newswise.com/articles/prostate-cancer-patients-face-financial-toxicity-who-is-affected-and-how-do-they-cope