Half of men with metastatic prostate cancer face treatment-related financial toxicity

ByJennifer R. Southall

Fact checked byMindy Valcarcel, MS

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Key takeaways:

Over half of men with metastatic prostate cancer experienced some level of financial hardship.
Patients with high financial toxicity more likely reduce spending on basic goods and leisure activities.

More than half of men treated for metastatic prostate cancer reported experiencing some degree of financial hardship, according to study results published in The Journal of Urology.

Men with metastatic prostate cancer and high financial toxicity appeared more likely to reduce spending on basic goods and leisure activities, results showed. They also appeared more likely to use savings to pay for care.

A survey of men with metastatic prostate cancer showed infographic

Rationale and methodology

Financial toxicity has been recognized as an important patient-centered outcome.

Prior research suggests up to half of cancer survivors are affected by financial toxicity, which has been linked to increased rates of adverse treatment outcomes.

Daniel D. Joyce, MD, urologic oncology fellow at Mayo Clinic in Rochester, Minnesota, and colleagues administered surveys — including the COST-FACIT (Comprehensive Score for Financial Toxicity) and coping mechanism questionnaires — to all men with metastatic disease who received treatment during a 3-month period at their institution’s advanced prostate cancer clinic.

Researchers used Fisher’s exact test to compare coping mechanisms between 281 patients (median age, 69 years; 94% white; 87% married; 51% with an annual income of at least $80,000) who experienced low (COST-FACIT > 24) or high (COST-FACIT 24) financial toxicity. Researchers also used multivariable linear regression to evaluate characteristics associated with lower financial toxicity.

Findings

More than one-quarter (28.1%; n = 79) of men reported high financial toxicity.

Multivariable analysis revealed three factors associated with lower financial toxicity. These included older age (estimate, 0.36; 95% CI, 0.21-0.52), applying for patient assistance programs (estimate, 4.42; 95% CI, 1.72-7.11) and annual income of at least $100,000 (estimate, 7.81; 95% CI, 0.97-14.66).

A higher percentage of patients with high financial toxicity than low financial toxicity received infusion therapies (20% vs. 5.3%; P < .001).

Men who experienced high financial toxicity appeared more likely than those with low financial toxicity to decrease their spending on basic goods (35% vs. 2.5%; P < .001) and leisure activities (59% vs. 15%; P > .001). They also appeared more likely to use savings to pay for their treatment (62% vs. 17%; P < .001).

Researchers acknowledged study limitations, including the single, quaternary-care referral center design and the inability to account for certain characteristics when measuring nonrespondent bias, which may not have accounted for important unmeasured confounders such as disease stage and insurance benefit design.

Implications

The findings provide important insights into previously undescribed aspects of financial toxicity among men with advanced prostate cancer, according to the researchers.

“Such data are crucial to understand how to include financial toxicity in shared decision-making and to guide future interventions designed to reduce financial toxicity in this population,” the researchers wrote.