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Master of Public Health

The Association between Financial Toxicity and Treatment Regret in Men with Localized Prostate Cancer

AUTHORS

Joyce DD , Wallis CJD , Huang LC , Hoffman KE , Zhao Z , Koyama T , Goodman M , Hamilton AS , Wu XC , Paddock LE , Stroup A , Cooperberg MR , Hashibe M , O'Neil BB , Kaplan SH , Greenfield S , Penson DF , Barocas DA , . JNCI cancer spectrum. 2022 10 18; ().

ABSTRACT

BACKGROUND: 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.

METHODS: 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.

RESULTS: 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).

CONCLUSIONS: 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.

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