UPJ INSIGHT Predictors of Financial Toxicity Among United States Prostate Cancer Survivors: A National Survey

By: Benjamin V. Stone, MD, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, Massachusetts General Hospital, Boston; Muhieddine Labban, MD, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts; Dejan K. Filipas, MD, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts; Edoardo Beatrici, MD, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts; Nicola Frego, MD, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts; Zhiyu (Jason) Qian, MD, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts; Sandeep S. Voleti, MPH, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts; Stuart R. Lipsitz, ScD, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts; Adam S. Kibel, MD, Brigham and Women’s Hospital, Boston, Massachusetts; Quoc-Dien Trinh, MD, MBA, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts; Alexander P. Cole, MD, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts | Posted on: 19 Sep 2023

Stone BV, Labban M, Filipas DK, et al. Predictors of financial toxicity among United States prostate cancer survivors: results from a national survey. Urol Pract. 2023;10(5):459-466.

Study Need and Importance

Cancer survivorship in the United States is associated with high rates of financial toxicity. Prostate cancer is the most common noncutaneous malignancy in American men, but the burden of financial toxicity in prostate cancer survivors has not been well characterized.

In this study we sought to assess the prevalence of subjective and objective measures of financial toxicity among prostate cancer survivors using the Medical Expenditure Panel Survey Cancer Self-administered Questionnaire. We also aimed to identify the predictors of financial toxicity in this cohort to identify those most at risk.

What We Found

Among 412 respondents with a history of prostate cancer, representative of 2,349,532 men after application of survey weights, there were high rates of both subjective and objective measures of financial toxicity (see Table). Of respondents, 13.5% reported catastrophic health care expenditures or out-of-pocket health care costs greater than 10% of annual income. On multivariable logistic regression analysis, significant predictors of catastrophic health care expenditures included private insurance (OR 4.62, 95% CI 1.29-16.49) and medical comorbidities (OR 1.38, 95% CI 1.05-1.82), while high income was protective (>400% vs <100% federal poverty level, OR 0.06, 95% CI 0.02-0.19). Each year of older age was associated with decreased odds of subjective worry about medical bills. Only 12% of men reported their doctor discussed the costs of care in detail.

Table. Measures of Financial Toxicity in the Study Cohort

	No.	%
Worry about paying medical bills	400	15.9
Using food stamps	405	3.5
Unable to cover medical bills	400	6.6
Early retirement	205	12.0
Borrow money or in debt	398	2.5
Change in work due to cancer	412	15.3
Delay or forgo cancer treatment due to cost	72	6.8
Delay or forgo prescriptions due to cost	72	14.3
Delay or forgo specialist visit due to cost	72	13.7
Worry about income instability	240	13.0
Cut spending on basic needs (eg, food and clothing)	103	12.5
Catastrophic health expenditures	412	13.5

Limitations

Limitations of this study include the use of survey data, which are subject to recall bias. Additionally, robust clinical data on treatment modality and disease severity are not available in the Medical Expenditure Panel Survey data set.

Interpretation for Patient Care

This study demonstrates the rates of subjective and objective measures of financial toxicity in a nationally representative prostate cancer population. These data may inform counseling to ensure patients are well informed about cost implications of prostate cancer and may guide interventions such as financial counseling for those most at risk, particularly young, privately insured men with low income.