Fifty percent of patients with metastatic prostate cancer experience some level of monetary hardship attributable to their treatment, in response to a study within the August issue of The Journal of Urology®, an Official Journal of the American Urological Association (AUA). The journal is published within the Lippincott portfolio by Wolters Kluwer.

“Our findings assist in understanding the rates of and risk aspects for financial toxicity amongst patients with advanced prostate cancer, together with the coping mechanisms, including the impact on personal spending, experienced by those reporting higher levels of monetary toxicity,” comments senior creator Stephen A. Boorjian, MD, of Mayo Clinic, Rochester, Minn.

“Our most important finding could also be that patients experience financial toxicity despite their ability to stay compliant with treatment,” says lead creator Daniel D. Joyce, MD. “Simply asking patients whether or not they are following their suggested treatments is just not sufficient to screen for financial toxicity.”

Recent data on financial toxicity rates, risk aspects, and coping strategies

The researchers administered a validated questionnaire concerning financial toxicity to all patients seen at their advanced prostate cancer clinic over a three-month period. Financial toxicity – which has been defined as “the harm to patients that results from treatment costs” – has change into recognized as necessary patient-centered consequence. Previous reports suggest that as much as half of cancer survivors are affected by financial toxicity, which has been linked to increased rates of antagonistic treatment outcomes.

Drs. Joyce and Boorjian and colleagues assessed the speed of monetary toxicity and the related patient characteristics and coping strategies amongst patients being treated for metastatic prostate cancer. The evaluation included responses from 281 patients, median age 69 years.

Based on the study questionnaire, 79 patients were classified as having high financial toxicity. Overall, 54% of patients said they experienced not less than some level of monetary hardship related to their cancer treatment. The impact was “more profound” amongst patients with high financial toxicity, with 89% percent reporting financial hardship.

Patients may make ‘profound personal sacrifices’ to stay compliant with prostate cancer treatments

Several patient characteristics were related to higher or lower risks of monetary toxicity. Older patients had lower financial toxicity, as each additional 12 months of age was related to a 25% reduction in risk. For patients who were married (or had a non-married partner), financial toxicity risk was nearly 4 times lower than for many who were single, widowed, or divorced. Not surprisingly, income was a big factor: risk of monetary toxicity was nine times lower for patients with annual incomes of $100,000, in comparison with incomes under $20,000.

Patients experiencing high financial toxicity coped in varied ways. They were more more likely to decrease spending on basic goods and leisure activities, to make use of their savings to pay for medical care, to delay filling prescriptions, and to borrow money to pay for his or her care. “Notably, only a few patients reported only partially filling medications or stopping medications altogether attributable to cost,” the researchers write.

Greater than half of patients with high financial toxicity reported difficulty paying bills – and patients on this group were more more likely to have delays in starting cancer treatment. Patients with high financial toxicity were also more more likely to use financial assistance programs: 32%, in comparison with 12% of those with low financial toxicity. “Patients are sometimes unable to satisfy the high treatment initiation costs without some variety of financial assistance program or subsidy,” the researchers write.

Dr. Joyce comments: “Some patients could also be making profound personal sacrifices so as remain adherent with their prostate cancer treatment, which can have a big impact on the standard of life that we hope to lengthen with these treatments. Conversations about these issues are much more crucial given the observed improvement in financial toxicity amongst patients in our study who were capable of access financial assistance programs.”

The researchers highlight the necessity to discover aspects that will mitigate the financial impact of treatments for metastatic prostate cancer. They conclude: “Such data are crucial to know easy methods to include financial toxicity in shared decision-making and to guide future interventions designed to scale back financial toxicity on this population.”