Financial Toxicity Common, Stressful in Metastatic Prostate Cancer
Natasha Persaud
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More than half of men with metastatic prostate cancer report at least some financial toxicity related to treatment, according to a survey.
In a study of 281 patients at a single institution, 151 men (54%) had some degree of financial hardship due to cancer, Daniel D. Joyce, MD, of Mayo Clinic in Rochester, Minnesota, and colleagues reported in The Journal of Urology. Among the 79 men with high financial toxicity, 89% had illness-related money troubles. These men were significantly more likely than those with low financial toxicity to decrease spending on basic goods, such as food and clothing (35% vs 2.5%) as well as leisure activities (59% vs 15%). These patients also more commonly raided their savings to pay for treatment (62% vs 17%).
Patients completed the COmprehensive Score for Financial Toxicity (COST-FACIT) and coping mechanism questionnaires. A COST-FACIT score of 24 or less defined high financial toxicity, whereas greater scores indicated low financial toxicity.
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“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,” Dr Joyce stated in a news release. “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.”
Men with lower financial toxicity tended to be older and had 7.8-fold increased odds of an annual income of at least $100,000. They also had 4.4-fold increased odds of applying for patient assistance programs.
Asked whether cost should figure into the treatments recommended by their clinician, 53% of those with high financial toxicity and 34% of those with low financial toxicity believed cost should have some or significant influence. Two-thirds (68%) of those with high financial toxicity never applied for a patient assistance program.
Dr Joyce’s team noted that prices for new cancer drugs typically outpace wages and inflation. Patients may receive numerous treatments over the course of their disease. Combination and sequential treatments are increasingly used to manage metastatic prostate cancer. A significantly greater proportion of men with high vs low financial toxicity in this study received infusion therapies (20% vs 5.3%).
Few patients overall skipped doses or stopped medications due to cost.
“Our most significant finding may be that patients experience financial toxicity despite their ability to remain compliant with treatment,” Dr Joyce stated. “Simply asking patients whether they are following their suggested treatments is not sufficient to screen for financial toxicity.”
“[Financial toxicity] must be discussed with every new cancer patient and be brought up in follow-up visits,” Hanan Goldberg, MD, of SUNY Upstate Medical University in Syracuse, New York, stated in an accompanying editorial. “This can help patients make informed decisions and apply for financial assistance programs in time, potentially lowering [financial toxicity]. Whenever possible, we must strive to provide care that is maximally oncologically effective and minimally financially toxic.”
In a second study published in The Journal of Urology, Dr Joyce and colleagues examined the effects of a Medicare low-income subsidy on access to metastatic prostate cancer treatment other than androgen deprivation therapy among 5929 older men. Patients with vs without the low-income subsidy still were less likely to initiate supplementary systemic therapy, whether oral or intravenous, and had worse overall survival.
Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.
References
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. 2023 Aug;210(2):290-298. doi: 10.1097/JU.0000000000003506
Prostate cancer patients face financial toxicity: Who is affected and how do they cope? News release. Wolters Kluwer; July 7, 2023.
Joyce DD, Qin X, Sharma V, et al. The impact of Medicare low-income subsidy on access to treatment, treatment choice, and oncologic outcomes in patients with metastatic prostate cancer. J Urol. Published online June 21, 2023. doi:10.1097/JU.0000000000003592
