TY - JOUR
T1 - Patient-Reported Financial Toxicity Associated with Contemporary Treatment for Localized Prostate Cancer
AU - Stone, Benjamin V.
AU - Laviana, Aaron A.
AU - Luckenbaugh, Amy N.
AU - Huang, Li Ching
AU - Zhao, Zhiguo
AU - Koyama, Tatsuki
AU - Conwill, Ralph
AU - Hoffman, Karen
AU - Joyce, Daniel D.
AU - Goodman, Michael
AU - Hamilton, Ann S.
AU - Wu, Xiao Cheng
AU - Paddock, Lisa E.
AU - Stroup, Antoinette
AU - Cooperberg, Matthew R.
AU - Hashibe, Mia
AU - O'Neil, Brock B.
AU - Kaplan, Sherrie H.
AU - Greenfield, Sheldon
AU - Penson, David F.
AU - Barocas, Daniel A.
N1 - Publisher Copyright:
© 2021 Lippincott Williams and Wilkins. All rights reserved.
PY - 2021/3/1
Y1 - 2021/3/1
N2 - 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.
AB - 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.
KW - costs and cost analysis
KW - patient reported outcome measures
KW - prostatic neoplasms
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U2 - 10.1097/JU.0000000000001423
DO - 10.1097/JU.0000000000001423
M3 - Article
C2 - 33252300
AN - SCOPUS:85102088471
SN - 0022-5347
VL - 205
SP - 761
EP - 768
JO - Journal of Urology
JF - Journal of Urology
IS - 3
ER -