AUA 2017: Financial Toxicity Prevalence and Delay in Care Among Bladder Cancer Patients

Boston, MA ( Maianne Casilla-Lennon, University of North Carolina, reviewed bladder cancer cases at their institution in order to define the prevalence of financial toxicity and identify causes for delay in care. A total of 144 bladder cancer patients were identified and 138 completed baseline questionnaires through the University of North Carolina Health Registry/Survivorship Cohort. Financial toxicity was defined as if the patient affirmed ‘you have to pay more for medical care than you can afford’. Patient demographics, clinical and pathologic characteristics were assessed.

Median age of the cohort was 66.9 years with majority being male (75%) and Caucasian (89%) race/ethnicity. Out of the 138 patients, 33(24%) endorsed financial toxicity. Patients who were younger, non-Hispanic black, and have less than a college degree education (all p<0.001) were more likely to elicit financial toxicity. In regards to disease, patients with non-muscle invasive bladder cancer were significantly more likely to report financial toxicity than those with muscle-invasive bladder cancer (30% v 15%, p=0.04).

Delay of care defined according to subject interpretation (i.e. questionnaire) was assessed according to financial toxicity. There was no significant difference in delay of care according to reported financial toxicity, however, 35% v 20% of patients who reported financial toxicity also reported delay in care (p=0.07). Among patients who reported financial toxicity, taking time of work and inability to afford general expenses were significant predictors for delay of care (both p=0.04).

In conclusion, financial toxicity was reported in ¼ of bladder cancer patients with younger, non-Hispanic black and those with less than a college degree level education more likely to have financial toxicity. Patients with non-muscle invasive bladder cancer were more likely to have financial toxicity suggesting surveillance measures may be a more costly burden for these patients. Future research aimed at addressing financial toxicity and bladder cancer care are needed. At my institution, we serve a large number of patients who are at risk for financial toxicity with limited funding support for the state to treat these patients. While financial toxicity is prevalent we must not alter our standard of care in order to treat these patients and urgent efforts are needed to ensure these patients receive appropriate care in a timely manner.

Presented By: Maianne Casilla-Lennon, University of North Carolina

Written By: Stephen B. Williams, M.D., Assistant Professor in Urology, The University of Texas Medical Branch, Galveston, TX. and Ashish M. Kamat, M.D. Professor, Department of Urology, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX.

at the 2017 AUA Annual Meeting - May 12 - 16, 2017 – Boston, Massachusetts, USA