Financial Toxicity Among Long-Term Prostate Cancer Survivors-Results From a Population-Based Cohort

Financial toxicity is a broadly defined term related to the negative financial consequences, objective and subjective, of medical treatment. We examined the association between objective financial toxicity and socioeconomic, clinical, and treatment-related factors in patients with prostate cancer.

The North Carolina Prostate Cancer Comparative Effectiveness and Survivorship Study (NC ProCESS) enrolled patients across NC with newly diagnosed prostate cancer between 2011 and 2013. Patients were enrolled prior to treatment and followed prospectively. Financial toxicity was assessed at 8-10 years after treatment using 5 questions taken from the National Health Interview Survey annual core questionnaire. Recurrence was defined for radical prostatectomy as PSA greater than 0.2ȯng/mL and for radiation therapy as 2ȯng/mL above the postradiation therapy nadir. Multivariable logistic regression assessed the association between financial toxicity and the relevant covariates.

A total of 547 White and Black patients completed the financial toxicity assessment at 8-10 years. This is a diverse cohort with 22.9% Black and 21.4% living in rural areas. On multivariable analysis, Black race (OR 1.93, P = .04) and annual household income of less than $90,000 (P < .01) had higher odds of financial toxicity. Recurrence was not associated with financial toxicity (OR 1.25, P = .61).

Among long-term prostate cancer survivors, race and income were associated with financial toxicity. This study increases our understanding of financial toxicity to drive patient- and policy-level efforts to improve the overall quality of life in long-term prostate cancer survivors.