Many Patients With Prostate Cancer May Face Treatment-Related Financial Toxicity

Patients with metastatic prostate cancer who face high financial toxicity resulting from treatment may cope in ways that impact overall quality of life, according to a survey-based study published in The Journal of Urology.¹

"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," senior study author Stephen A. Boorjian, MD, of Mayo Clinic in Rochester, MN, said in a press release.²

Up to 48% of cancer survivors experience financial toxicity, which can substantially impact quality of life, increase mortality, and worsen symptom burden.

Financial toxicity, which the study authors define as “the harm to patients that results from treatment costs,” has become a noted patient-centered outcome in cancer treatment due to the high costs of oncology drugs. According to the authors, the prevalence of financial toxicity has been estimated to be up to 48% in cancer survivors. Financial toxicity can substantially impact patient quality of life, result in higher mortality, and increase symptom burden.

The study authors aimed to characterize financial toxicity in patients with metastatic prostate cancer, explore the characteristics associated with lower financial toxicity, and identify the coping mechanisms patients turn to. This was done through surveys of patients seen at the Advanced Prostate Cancer Clinic at Mayo Clinic in Rochester, Minnesota, between February 22 to April 29, 2022.

Surveys used in the study included the COmprehensive Score for Financial Toxicity–Functional Assessment of Chronic Illness Therapy (COST-FACIT) and coping mechanism questionnaires, with high financial toxicity defined a reported COST-FACIT score of 24 or lower and low financial toxicity defined as a COST-FACIT score higher than 24. Comparisons of coping mechanisms between patients with low and high financial toxicity were conducted using Fisher’s exact test, and characteristics associated with lower financial toxicity were identified via multivariable linear regression.

A total of 281 patients met inclusion criteria, which included being over the age of 18 and having a diagnosis of metastatic prostate cancer. Of these patients, 79 reported experiencing high financial toxicity and 202 reported low financial toxicity.

A multivariable analysis showed that older age, applying for patient assistance programs, previous surgical management of prostate cancer, and higher household income were associated with lower financial toxicity.

At the time of the survey, 77% of patients were being treated with androgen deprivation therapy (ADT) monotherapy, 29% were receiving novel hormonal therapies, 15% were receiving infusion therapies, and 5.3% were receiving immuno-oncology therapies. In 17 patients, 2 or more synchronous, non-ADT treatments were used. A significantly higher proportion of patients with high financial toxicity were undergoing treatment with infusion therapies (20%) vs patients who reported lower financial toxicity (5.3%; P = .001).

Those who reported high financial toxicity resulting from treatment were more likely to reduce the amount of money spent on basic goods and leisure activities, use savings to pay for care, delay prescription fulfillment, and borrow money to pay for medications.

The authors noted a few limitations, including the study’s single-center nature, meaning the results may not be generalizable to the broader population. Because practice patterns in advanced prostate cancer are known to vary, the authors noted that the strategies used to manage the disease at the study clinic and availability of financial assistance may also vary. The survey responses were also not linked to electronic medical records, so characteristics that could impact nonrespondent bias or unmeasured confounding factors such as disease stage or insurance type were not included.

Despite limitations, the findings suggest that approximately half of men with metastatic prostate cancer experience financial toxicity to some degree, and quality of life may be impacted by treatment-related financial hardships, the authors concluded.

"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,” said lead author Daniel D. Joyce, MD.² “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."

References

1. Joyce DD, Schulte PJ, Kwon EG, et al. Coping mechanisms for financial toxicity among patients with metastatic prostate cancer: a survey-based assessment. J Urol. 2023;210(2):290-298. 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. July 7, 2023. Accessed July 12, 2023. https://www.newswise.com/articles/prostate-cancer-patients-face-financial-toxicity-who-is-affected-and-how-do-they-cope