ACS 2019: A Cross-Sectional Study Evaluating Financial Toxicity among Bladder Cancer Patients

San Francisco, California ( Mark Ehlers, MD, University of North Carolina, Chapel Hill, NC, reviewed how bladder cancer is the most expensive cancer from diagnosis to death. Financial toxicity (FT) is distress related to the cost of medical care. Worse FT has been reported in younger, Black, less educated, and non-muscle-invasive disease bladder cancer patients.

In their study, they hypothesized that a validated questionnaire would demonstrate variation in FT among bladder cancer patients based on personal and financial characteristics. Through the Bladder Cancer Advocacy Network Patient Survey Network, patients completed an online survey including the validated COST questionnaire (COmprehensive Score for financial Toxicity). Lower COST scores correspond to worse FT. Linear regression modeling was performed with SAS v9.4.

 A total of 231 patients (>75%) completed the survey. The mean age was 66.1 years with 64% male, 72% college-educated, 49% with Medicare, an average of 65 months since diagnosis, and 51% employed full time. The average COST score was 28.41 (CI 26.88-29.94; range 0-44). Significantly worse FT was found among patients with: out-of-pocket costs (COST 25.75; p<0.0001), lost income due to cancer (COST 20.82; p<0.0001), cancer costs necessitating employment (COST 18.07; p<0.0001), full time employment (COST 25.40; p<0.0001), Medicaid only insurance (COST 12.20; p=0.1027), private insurance (COST 20.84; p<0.0001), employer-purchased insurance (COST 25.93; p=0.0424), insurance plan changes since treatment (COST 25.08; p=0.0001), less than a college degree (COST 24.05; p=0.0117), and diagnosis 1-5 years ago (COST 27.08, p=0.0152). No differences in COST were noted based on stage (p=0.24). In summary, this cross-sectional survey demonstrated worse FT depending on multiple factors related to education, employment, treatment cost, insurance and time since diagnosis.

Presented by: Mark Ehlers, MD, 3rd Year Resident, University of North Carolina, School of Medicine, Department of Urology, University of North Carolina, Chapel Hill, North Carolina

Written by: Stephen B. Williams, MD, Medical Director for High Value Care; Chief of Urology, Associate Professor, Director of Urologic Oncology, Director Urologic Research, The University of Texas Medical Branch at Galveston, TX at the 2019 American College of Surgeons (ACS), #ACSCC19, October 27–31 in San Francisco, California