Patient-Reported Financial Toxicity Associated with Contemporary Treatment for Localized Prostate Cancer

Authors

Benjamin V. Stone, Vanderbilt University Medical Center
Aaron A. Laviana, Vanderbilt University Medical Center
Amy N. Luckenbaugh, Vanderbilt University Medical Center
L Li-Ching Huang, Vanderbilt University Medical Center
Zhiguo Zhao, Vanderbilt University Medical Center
Tatsuki Koyama, Vanderbilt University Medical Center
Ralph Conwill, Vanderbilt University Medical Center
Karen Hoffman, University of Texas M. D. Anderson Center
Daniel D. Joyce, Vanderbilt University Medical Center
Michael Goodman, Emory University
Ann S. Hamilton, University of Southern California
Xiao-Cheng Wu, LSU Health Sciences Center - New OrleansFollow
Lisa E. Paddock, Rutgers Health
Antoinette Stroup, Rutgers Health
Matthew R. Cooperberg, University of California, San Francisco
Mia Hashibe, University of Utah
Brock B. O'Neil, University of Utah
Sherrie H. Kaplan, University of California Irvine
Sheldon Greenfield, University of California Irvine
David F. Penson, Vanderbilt University Medical Center
Daniel A. Barocas, Vanderbilt University Medical Center

Document Type

Article

Publication Date

11-30-2020

Publication Title

Journal of urology

Abstract

Purpose: Contemporary treatment modalities for localized prostate cancer provide comparable overall and cancer-specific survival. However, the degree of financial burden imposed by treatment, the factors contributing to that burden, and how different treatments compare with regard to financial toxicity remain poorly understood. Materials and methods: The Comparative Effectiveness Analysis of Surgery and Radiation (CEASAR) study enrolled men with localized prostate cancer from 2011 to 2012. Questionnaires were collected at 6, 12, 36, and 60 months after enrollment. Differences in patient-reported financial burden were compared between active surveillance, radical prostatectomy, and external beam radiotherapy using multivariable logistic regression. Results: Among 2,121 patients meeting inclusion criteria, 15% reported large or very large burden of treatment costs within 6 months, declining to 3% by year 5. When controlling for age, education, income and other covariates, external beam radiotherapy was associated with greater financial burden than active surveillance and radical prostatectomy at 1 year (OR 2.2, 95% CI 1.2-4.1 and OR 1.5, 95% CI 1.0-2.3, respectively) and 3 years (OR 3.1 95% CI 1.1-8.8 and OR 2.1, 95% CI 1.2-3.7, respectively). Radical prostatectomy and active surveillance had similar rates of financial burden at all time points. Age, race, education, and D'Amico risk group were associated with financial burden. Conclusions: External beam radiotherapy was associated with the highest financial burden, even when controlling for age, education and income. Prospective studies that directly measure out-of-pocket and indirect costs and account more thoroughly for baseline socioeconomic differences are warranted in order to identify those most at risk.

PubMed ID

33252300

Volume

205(3)

Recommended Citation

Stone, Benjamin V.; Laviana, Aaron A.; Luckenbaugh, Amy N.; Huang, L Li-Ching; Zhao, Zhiguo; Koyama, Tatsuki; Conwill, Ralph; Hoffman, Karen; Joyce, Daniel D.; Goodman, Michael; Hamilton, Ann S.; Wu, Xiao-Cheng; Paddock, Lisa E.; Stroup, Antoinette; Cooperberg, Matthew R.; Hashibe, Mia; O'Neil, Brock B.; Kaplan, Sherrie H.; Greenfield, Sheldon; Penson, David F.; and Barocas, Daniel A., "Patient-Reported Financial Toxicity Associated with Contemporary Treatment for Localized Prostate Cancer" (2020). School of Public Health Faculty Publications. 314.
https://digitalscholar.lsuhsc.edu/soph_facpubs/314
10.1097/JU.0000000000001423