In men with early-stage prostate cancer, the choice of initial treatment carries different risks for "financial toxicity," reports a study in the Journal of Urology®, the official gazette of the American Urological Association (AUA). The magazine is published by Wolters Kluwer in the Lippincott portfolio.
The cost of cancer treatment can be high, and the financial burden of treating prostate cancer can be a significant source of stress for men and their families.
"Treatment costs and the associated financial burden could be an important factor in treatment decisions," says Daniel A. Barocas, MD, MPH, Associate Professor of Urology and Medicine at Vanderbilt University, Nashville, Tennessee, and senior author of this new paper . Financial toxicity is a relatively new term in cancer treatment and can be defined as "the distress or distress patients experience because of the cost of cancer treatment".
Differences in the financial burden of initial treatment for localized prostate cancer
Prostate cancer is one of the most common types of cancer in men. An estimated 190,000 new cases will be diagnosed this year. Because their cancer has not spread beyond the prostate, men with localized disease have a choice of several treatment options, including active surveillance, radiation, or surgery.
According to lead author Benjamin V. Stone, MD, "Modern treatments for localized prostate cancer provide comparable results with high rates of cancer control and patient survival." But does the financial burden differ depending on the choice of initial prostate cancer treatment? To find out, Drs. Stone, Barocas, and colleagues analyzed data on 2,121 patients from a follow-up study for the treatment of localized prostate cancer.
The study included a questionnaire that asked about the direct and indirect costs of prostate cancer and its treatment. The financial burdens were compared for patients who opted for surgery (radical prostatectomy), external radiation therapy (EBRT), or active monitoring. (Other treatment groups were considered too small for analysis.)
In the first six months after receiving treatment for prostate cancer, 15 percent of patients said they had a "large or very large" burden on treatment costs. The financial burden was highest in patients with EBRT: 11 percent of the patients reported burdens that were compatible with the financial toxicity.
Patients who chose to have surgery had a higher initial financial burden than patients who chose to actively monitor. However, these two groups were similar after a year. The financial burdens decreased over time: five years after treatment, only one to three percent of patients had financial toxicity.
Adjusted for other factors, the financial burdens associated with EBRT were up to twice as high as with operations or active surveillance.
Our research shows that radiation therapy appears to have the greatest financial burden in patients with clinically localized prostate cancer when compared to surgery or active surveillance. However, our study also shows that there is a relatively small percentage of patients who experience large or very large financial stress as a result of treatment, and the financial stress decreases over time. "
Benjamin V. Stone, MD, Director of Studies, Vanderbilt University
Other factors that contribute to a higher financial burden include: higher risk prostate cancer, younger age, non-white race, and lower education. "The relationship of financial burden to socioeconomic factors such as race and education is consistent with previous studies in the US and worldwide," said Dr. Stein and Barocas and co-authors write.
"Overall, our follow-up study suggests that radiation therapy poses a longer-lasting cost burden compared to other primary treatment options for prostate cancer," the researchers conclude. They note some limitations to their study, including a lack of data on patient income and other financial resources.
It is also unclear why the financial impact of EBRT is greater than that of other treatment options. Dr. Stone added, "Future studies should include data on out-of-pocket treatment costs as well as various types of indirect costs that affect the financial impact of prostate cancer treatment choices."
Stone, B.V., et al. (2020) Patient-reported financial toxicity associated with the contemporary treatment of localized prostate cancer. The Journal of Urology. doi.org/10.1097/JU.0000000000001423.