Holler JT, Hakam N, Nabavizadeh B et al: Characteristics of online crowdfunding campaigns for urological cancers in the United States. Urol Pract 2021; 56.

According to the National Cancer Institute, the cost of cancer care in the United States was $208.9 billion in 2020 and is expected to continue increasing (see figure).¹ As treatment becomes more expensive, an array of economic burdens increasingly falls on patients. In addition to the direct expenses of cancer treatment, patients incur indirect costs–loss of work, family expenses and travel costs. These complex financial stressors contribute to the increasingly recognized financial toxicity of cancer.² Financial toxicity, like other treatment toxicity (eg medication side effects), contributes to lower compliance with care and decreased medication adherence.²

Figure. Estimates of national expenditures for cancer care (in billions of U.S. dollars [USD]) by cancer site and year.¹

New strategies to fundraise for a person’s cancer care may provide a window into health care inequities by revealing the full range of financial hardships encountered by patients and their support systems.³ In particular, online crowdfunding is now a common strategy for patients and their families to raise money to support their health care costs.⁴ Medical campaigns account for more than $650 million in donations annually through GoFundMe^®, the largest online crowdfunding platform.⁵ As the cost of health care continues to rise, crowdfunding serves as a means to cover health-related expenses. However, while raising funds may lessen individual financial pressures, crowdfunding does not fully address the broader unmet health care needs of patients.

Owing to the use of multiple advanced modalities and a protracted natural history, the survival rates of urological cancers have improved dramatically in the last few decades but these remain among the most expensive cancers to treat.⁶ There is a paucity of research exploring the characteristics of urological cancer crowdfunding campaigns. Understanding the financial needs of these patients guides clinical decision making for urologists and informs policy makers on the gaps in health care filled by crowdfunding. The highlighted study explores the characteristics of GoFundMe campaigns seeking financial relief for expenses related to urological cancers.⁷

A total of 1,234 adult and pediatric patients with major urological cancers were included and narratives were reviewed to identify characteristics predicting campaign success, including demographic information, insurance status, campaign author identity and primary funding purpose (table 1). The study found that campaign authorship, primary narrative appeal and cancer type were key factors to the financial success of a medical crowdfunding campaign.⁷

The study found that campaign authorship is a key contributor to the financial success of a crowdfunding campaign. In the highlighted study, not only were most campaigns written by friends or family, but those campaigns also received more donations and higher donation amounts than self-authored campaigns (table 2).⁷ Crowdfunding relies heavily on the size and depth of social networks. Campaigns written by others may better reach audiences outside the patient’s existing social network than those self-authored.

The emergence of online medical crowdfunding can help illuminate the scale of unmet financial needs encountered through contemporary urological cancer care. A closer look at the patterns of successful campaigns may also reveal insights about prevailing social ideas on who is deserving of charity.⁸ In this study, campaign narratives that focused on one’s high moral character and contributions to society received more donations than those focused on disheartening circumstances, such as multiple negative events leading to the present devastating situation. Good character and past generosity draw on values of fairness and reciprocity, which are both strong motivators for collective action and charitable giving behaviors.⁸

Primary malignancy type played a significant role in both the number of donations and average donation amount in campaigns. Testicular cancer campaigns received the highest number of donations; however, bladder cancer campaigns received the largest average donation amount (tables 2 and 3). Excluding testicular cancers, only 9% of all other urological cancers reached their financial goals (table 1).

Compared to all other cancer patients, those with bladder cancer incur the highest lifetime treatment costs due to the diagnostic and therapeutic tools necessary to manage the illness.⁹ Thus, while these campaigns received the most money, most campaigns did not reach their stated fundraising goal, reflecting potentially unmet financial burdens.

In the last 30 years, while new techniques, pharmacological options and treatment modalities have improved survival in patients faced with urological cancers, it has become increasingly difficult to improve health while maintaining reasonable costs and affordable care.⁴ Urological cancer patients, representing a substantial portion of all cancer cases in the U.S., face a large burden of cancer-related financial toxicity.⁶ The rising popularity of medical crowdfunding is concerning as it is a reflection of the unmet financial needs experienced by this population.⁸ As therapy improves, an important consideration must be placed on developing cost-effective approaches to lessen the financial toxicity for these patients.¹⁰ Clinicians can also focus on minimizing the financial toxicity of cancer care by involving financial counselors, insurance eligibility workers and social workers to address patient needs when appropriate.