Financial toxicity is emerging as an important patient centered outcome and is understudied in prostate cancer patients. We sought to understand the association between financial burden and treatment regret in men with localized prostate cancer to better evaluate the role of financial discussions in patient counseling.
Utilizing the Comparative Effectiveness Analysis of Surgery and Radiation dataset, we identified all men accrued between 2011 and 2012 who underwent surgery, radiation, or active surveillance for localized prostate cancer. Financial burden and treatment regret were assessed at 3- and 5-year follow-up. The association between financial burden and regret was assessed using multivariable longitudinal logistic regression controlling for demographic and disease characteristics, treatment, functional outcomes, and patient expectations.
Of the 2,924 eligible patients, both regret and financial burden assessments for 3- and/or 5-year follow-up were available for 81% (n = 2,359). After adjustment for relevant covariates, financial burden from "finances in general" was associated with treatment regret at 3 years (OR 2.47, 95% CI 1.33-4.57, p = 0.004); however, this association was no longer statistically significant at 5 year follow-up (OR 1.19, 95% CI 0.56-2.54, p = 0.7).
In this population-based sample of men with localized prostate cancer, we observed associations between financial burden and treatment regret. Our findings suggest indirect treatment costs, especially during the first three years after diagnosis, may impact patients more profoundly than direct costs and are important for inclusion in shared decision-making.
JNCI cancer spectrum. 2022 Oct 18 [Epub ahead of print]
Daniel D Joyce, Christopher J D Wallis, Li-Ching Huang, Karen E Hoffman, Zhiguo Zhao, Tatsuki Koyama, 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, Mayo Clinic, Rochester, MN, USA., Department of Surgery, Division of Urology, University of Toronto, Toronto, Ontario, Canada., Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA., Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA., Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia, USA., Department of Population and Public Health Sciences, Keck School of Medicine at the University of Southern California, Los Angeles, California, USA., Department of Epidemiology, Louisiana State University New Orleans School of Public Health, New Orleans, Louisiana, USA., Department of Epidemiology, Cancer Institute of New Jersey, Rutgers Health, New Brunswick, New Jersey, USA., Department of Urology, University of California, San Francisco, California, USA., Department of Family and Preventative Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA., Department of Urology, University of Utah Health, Salt Lake City, Utah, USA., Department of Medicine, University of California Irvine, Irvine, California, USA., Department of Urology, Vanderbilt University Medical Center, Nashville, TN, USA.