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.
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.
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 one 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.
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.
The Journal of urology. 2020 Nov 30 [Epub ahead of print]
Benjamin V Stone, Aaron A Laviana, Amy N Luckenbaugh, Li-Ching Huang, Zhiguo Zhao, Tatsuki Koyama, Ralph Conwill, Karen Hoffman, Daniel D Joyce, Michael Goodman, Ann S Hamilton, Xiao-Cheng Wu, Lisa E Paddock, Antoinette Stroup, Matthew R Cooperberg, Mia Hashibe, Brock B O'Neil, Sherrie H Kaplan, Sheldon Greenfield, David F Penson, Daniel A Barocas
Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee., Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee., Office of Patient and Community Education, Patient Advocacy Program, Vanderbilt Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee., Department of Radiation Oncology, University of Texas M. D. Anderson Center, Huston, Texas., Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia., Department of Preventative Medicine, Keck School of Medicine at the University of Southern California, Los Angeles, California., Department of Epidemiology, Louisiana State University New Orleans School of Public Health, New Orleans, Louisiana., Department of Epidemiology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey., Department of Urology, University of California, San Francisco, California., Department of Family and Preventative Medicine, University of Utah School of Medicine, Salt Lake City, Utah., Department of Urology, University of Utah Health, Salt Lake City, Utah., Department of Medicine, University of California Irvine, Irvine, California.