EIKCS 2022: Caring for the Whole Patient: Cost of Treatment for Renal Cell Carcinoma

(UroToday.com) The 2022 International Kidney Cancer Symposium (IKCS) European Annual meeting included a session addressing non-clinical considerations for caring for the whole kidney cancer patient and a presentation by Dr. Michael Staehler discussing the cost of treatment/follow-up for renal cell carcinoma (RCC). Dr. Staehler started by highlighting that there are many components to the framework of financial toxicity and financial distress. These include direct and indirect costs, as well as objective and subjective reasons for financial distress:1

 

EIKCS2022_Staehler_0 

 

 Costs may also vary from a patient and provider standpoint. In a study from Germany by Michaeli et al.2 assessing follow-up cost for RCC, spending increased by +32% from 2000 to 2020 for low-risk RCC, while medium-and high-risk RCC cost was cut by -39% and -22%, respectively. Patients carried 27% of the cost, providers 43% and insurers 35% of costs in 2020. Resources were consumed by medical imaging (52%), physician-patient consultations (31%), travel expenses (17%) and blood tests (1%). As follows is the breakdown for patient and provider costs, stratified by year:

 

 

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In a survey comprising patients with localized disease undergoing surveillance (n=23), localized disease undergoing surgery (n=187), and metastatic disease (n=280), patients with an income of less than $50,000 USD were significantly more anxious about financial hardship than people with higher income (> $100,000 USD; 93% vs 82%, p <0.001). Additionally, 59% were concerned that their money in saving or retirement assets would not cover the cost of medical treatment. Furthermore:

  • 8% were satisfied with their financial situation and 25% were financially stressed
  • 26% were concerned about losing their job and income
  • 32% claimed that their cancer treatment reduced their satisfaction with their present financial situation
  • 50% did not feel in control of their financial situation
  • 8% were confident about their finances

Dr. Staehler and colleagues recently published a study assessing COVID-19 and financial toxicity in patients with RCC, conducting an online survey at the peak of the pandemic (March 22-March 25, 2020).3 To assess financial burden, the validated comprehensive score for financial toxicity (COST) patient-reported outcome measure was included. Among 539 patients (39% male; 58% female) from 14 countries, 23% of the patients did not feel in control of their financial situation but 8% reported being very satisfied with their finances. The median COST score was 21.5 (range 1–44). Metastatic patients who have not started systemic therapy had a COST score (19.8 range 2–41) versus patients on oral systemic therapy had a COST score (23.9 range 4–44). As follows is the COST score and anxiety related to different situations:

 

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Factors significantly associated with a lower COST score (more financial distress) included female gender (r = 0.108), younger age (r = 0.210), urban living situation (r = 0.68), lower educational level (r = 0.155), lower income (r = 0.165), higher anxiety about acquiring COVID-19 (r = 0.198), having metastatic disease (r = 0.073), and higher distress score about cancer progression (r = 0.224):

 

EIKCS2022_Staehler_3 

Dr. Staehler concluded his presentation by assessing the cost of RCC treatment and financial toxicity with the following take-home messages:

  • Financial toxicity is a patient-centered endpoint as an adverse event of therapy, leading to inferior oncological outcomes
  • Younger patients, women, and those with lower income seem to be at highest need of financial advising
  • Treatment and surveillance of RCC patients may have to be adjusted to contemplate financial and medical needs
  • Acknowledging financial hardship and uncertainty related to future costs and providing thorough counseling of cancer patients should be part of the conversation about therapy

 

Presented By: Michael Staehler, MD, Head of the Interdisciplinary Centre for Renal Tumors, Ludwig-Maximilians University of Munich, Munich, Germany

Written By: Zachary Klaassen, MD, MSc – Urologic Oncologist, Assistant Professor of Urology, Georgia Cancer Center, Augusta University/Medical College of Georgia, @zklaassen_md on Twitter during the 2022 International Kidney Cancer Symposium (IKCS) Europe Annual Hybrid Meeting, Antwerp, Belgium, Fri, Apr 22 – Sun, Apr 24, 2022.

References:

  1. Witte J, Mehlis K, Surmann B, et al. Methods for measuring financial toxicity after cancer diagnosis and treatment: A systematic review and its implications. Ann Oncol. 2019;30:1061—1070.
  2. Michaeli JC, Michaeli DT, Boch T, et al. Socioeconomic burden of disease: Survivorship costs for renal cell carcinoma. Eur J Cancer Care. 2022:1-11.
  3. Staehler MD, Battle DJ, Bergerot CD, et al. COVID-19 and financial toxicity in patients with renal cell carcinoma. World J Urol. 2021;39:2559-2565.