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UPJ INSIGHT Financial Toxicity Among Patients With Metastatic Prostate Cancer: A Mixed Methods Approach

By: Daniel D. Joyce, MD, MS, Vanderbilt University Medical Center, Nashville, Tennessee; Kasey R. Boehmer, PhD, MPH, Mayo Clinic, Rochester, Minnesota; Celia C. Kamath, PhD, Mayo Clinic, Rochester, Minnesota; Christina M. LaVecchia, PhD, Mayo Clinic, Rochester, Minnesota, University of Cincinnati, Ohio; Vidit Sharma, MD, MS, Vanderbilt University Medical Center, Nashville, Tennessee; Phillip J. Schulte, PhD, Mayo Clinic, Rochester, Minnesota; Jon C. Tilburt, MD, MPH, Mayo Clinic, Rochester, Minnesota; David F. Penson, MD, MPH, MMHC, Mayo Clinic, Scottsdale, Arizona Geriatric Research Education and Clinical Center, Veterans Affairs Tennessee Valley Healthcare System, Nashville; Stephen A. Boorjian, MD, Vanderbilt University Medical Center, Nashville, Tennessee | Posted on: 17 Jul 2024

Joyce DD, Boehmer KR, Kamath CC, et al. Financial toxicity among patients with metastatic prostate cancer: a mixed methods approach to identify effective interventions. Urol Pract. 2024;11(4):640-652. doi:10.1097/UPJ.0000000000000589

Study Need and Importance

Financial toxicity (FT), a term that is used to describe unintended harm to patients caused by the cost of cancer care, has been linked to poor treatment adherence, worse symptom burden, decreased quality of life, and mortality. While many of these findings are ubiquitous throughout cancer care, metastatic prostate cancer presents several facets that may uniquely impact patients’ experience with FT. Previously, we described FT and common coping mechanisms among patients with metastatic prostate cancer. Herein, we sought to expand on these findings by understanding what areas of FT are not adequately assessed through current measures, and to use patient experiences and preferences to inform interventions.

What We Found

Three themes were identified through qualitative analysis: (1) workload, (2) coping strategies, and (3) communication. Two unique aspects of FT emerged that were not assessed quantitatively and deemed to be significant. Specifically, cost transparency and inclusion of informal caregivers in FT screening and decision-making may guide future interventions aimed at limiting FT in this population.

Limitations

Patients included here were predominantly White and seen at a single quaternary care referral center; as such, the generalizability of our findings to other health care settings is uncertain. Furthermore, we purposefully chose patients experiencing extremes of FT for our analyses. While this approach helped identify important facilitators and obstacles to financial capacity, it limited our ability to understand the experience of patients experiencing less severe degrees of FT.

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Figure. Theory triangulation highlighting the importance of health care team knowledge, competence, cost transparency, and inclusion of informal caregivers on patients’ ability to cope with increasing workload from direct and indirect costs. QOL indicates quality of life.

Interpretation for Patient Care

In this convergent mixed methods study, 2 actionable suggestions to improve FT were noted (Figure): (1) decreasing the uncertainty of cost by creating knowledgeable health care teams who are willing and able to routinely engage in cost discussions, and (2) increasing informal caregiver involvement in FT assessments and shared decision-making processes.

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