Financial Toxicity Among Patients with Prostate, Bladder, and Kidney Cancer: A Systematic Review and Call to Action

Bhanvadia, Sumeet; Psutka, Sarah P.; Burg, Madeleine L.; Wit, Ronald de; Dhillon, Haryana M.; Gyawali, Bishal; Morgans, Alicia K.; Goldstein, Daniel A.; Smith, Angela; Sun, Maxine; Penson, David F.

doi:10.1016/j.euo.2021.02.007

Cited by 42 publications

(58 citation statements)

References 48 publications

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“…However, the interplay of SES and cancer outcomes is complex and multifaceted. 37 , 38 Proper management of oncologic disease involves numerous components, such as access to and quality of health care and material resources, all of which are intertwined with economic and social policies. Patients of lower SES may present at later stages for numerous reasons—for example, a lower frequency of primary and specialist care utilization or disproportionate exposure to carcinogenic environments.…”

Section: Discussionmentioning

confidence: 99%

Association of Race, Ethnicity, and Socioeconomic Status With Esthesioneuroblastoma Presentation, Treatment, and Survival

et al. 2022

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Objective Socioeconomic and other demographic factors are associated with outcomes in head and neck cancer. This study uses a national cancer database to explore how patient race, ethnicity, and socioeconomic status (SES) are associated with esthesioneuroblastoma outcomes, including 5-year disease-specific survival (DSS), conditional DSS, stage at diagnosis, and treatment. Study Design Retrospective cohort analysis. Setting Patients with esthesioneuroblastomas between 1973 and 2015 from the SEER registry (Surveillance, Epidemiology, and End Results). Methods The National Cancer Institute Yost Index, a census tract–level composite score composed of 7 parameters, was used to categorize the SES of patients. Kaplan-Meier analysis and Cox regression were conducted to assess DSS. Conditional DSS was calculated per estimates from simplified Cox models. Logistic regression was conducted to identify risk factors for advanced cancer stage at diagnosis and the likelihood of receiving multimodal therapy. Results Complete data were included for 561 patients. DSS was significantly associated with SES (log-rank, P < .01) but not race. According to Cox regression, DSS was worse for the lowest SES tertile vs the highest (hazard ratio, 1.70 [95% CI, 1.05-2.75]; P = .03). Patients of the lowest SES tertile exhibited an increased risk of advanced cancer stage at diagnosis as compared with the highest SES tertile (odds ratio, 1.84 [95% CI, 1.06-3.30]; P = .035). Black patients (odds ratio, 0.44 [95% CI, 0.24-0.84]; P = .011) were less likely than other patients to receive multimodal therapy. SES alone was not associated with receiving multimodal therapy. Conclusion SES is significantly associated with DSS and conditional DSS for patients with esthesioneuroblastomas. Inequalities in access to care and treatment likely contribute to these disparities.

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Section: Discussionmentioning

confidence: 99%

Association of Race, Ethnicity, and Socioeconomic Status With Esthesioneuroblastoma Presentation, Treatment, and Survival

et al. 2022

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“…Twenty-six (52%) studies defined FRP as a concept,37–62 with 23 (46%) studies specifically referring to FRP as a necessary step to achieving UHC 37–46 49–51 53–62. Some studies suggested that FRP is achieved when households are able to use safe, effective and high-quality health services, without sacrificing other necessities for well-being, such as nutrition 37–39 45 49 51 53 54.…”

Section: Resultsmentioning

confidence: 99%

“…Some studies suggested that FRP is achieved when households are able to use safe, effective and high-quality health services, without sacrificing other necessities for well-being, such as nutrition 37–39 45 49 51 53 54. Others considered FRP more narrowly as a means of reducing illness-related expenditures 40–42 48 52 57–60. This includes the concept of ‘financial toxicity’, which describes the distress and financial hardship experienced by patients and their caregivers following a cancer diagnosis 48 52.…”

Section: Resultsmentioning

confidence: 99%

“…Others considered FRP more narrowly as a means of reducing illness-related expenditures 40–42 48 52 57–60. This includes the concept of ‘financial toxicity’, which describes the distress and financial hardship experienced by patients and their caregivers following a cancer diagnosis 48 52. Studies further suggested that a lack of FRP may exacerbate health and socioeconomic inequities by reducing access to health services and discouraging or delaying care-seeking 39 47 50 56…”

Section: Resultsmentioning

confidence: 99%

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Identifying priorities for research on financial risk protection to achieve universal health coverage: a scoping overview of reviews

et al. 2022

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ObjectivesFinancial risk protection (FRP) is an indicator of the Sustainable Development Goal 3 universal health coverage (UHC) target. We sought to characterise what is known about FRP in the UHC context and to identify evidence gaps to prioritise in future research.DesignScoping overview of reviews using the Arksey & O’Malley and Levac & Colquhoun framework and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews reporting guidelines.Data sourcesMEDLINE, PsycINFO, CINAHL-Plus and PAIS Index were systematically searched for studies published between 1 January 1995 and 20 July 2021.Eligibility criteriaRecords were screened by two independent reviewers in duplicate using the following criteria: (1) literature review; (2) focus on UHC achievement through FRP; (3) English or French language; (4) published after 1995 and (5) peer-reviewed.Data extraction and synthesisTwo reviewers extracted data using a standard form and descriptive content analysis was performed to synthesise findings.Results50 studies were included. Most studies were systematic reviews focusing on low-income and middle-income countries. Study periods spanned 1990 and 2020. While FRP was recognised as a dimension of UHC, it was rarely defined as a concept. Out-of-pocket, catastrophic and impoverishing health expenditures were most commonly used to measure FRP. Pooling arrangements, expansion of insurance coverage and financial incentives were the main interventions for achieving FRP. Evidence gaps pertained to the effectiveness, cost-effectiveness and equity implications of efforts aimed at increasing FRP. Methodological gaps related to trade-offs between single-country and multicountry analyses; lack of process evaluations; inadequate mixed-methods evidence, disaggregated by relevant characteristics; lack of comparable and standardised measurement and short follow-up periods.ConclusionsThis scoping overview of reviews characterised what is known about FRP as a UHC dimension and found evidence gaps related to the effectiveness, cost-effectiveness and equity implications of FRP interventions. Theory-informed mixed-methods research using high-quality, longitudinal and disaggregated data is needed to address these objectives.

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“…From both an oncological and a macroeconomic point of view, a balanced discussion of the incremental costs of early diagnosis of prostate cancer versus the potential benefits should include ways to reduce overdiagnosis. Meanwhile, we must not overlook the financial toll of cancer on a personal level, as patients with a diagnosis of cancer are more likely than the average person to experience economic distress, such as problems with insurance and bankruptcy [10] . These consequences of a cancer diagnosis are undesirable and disproportionate for healthy men with clinically insignificant disease.…”

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confidence: 99%

Abandon the Label of Clinically Insignificant Prostate Cancer

Mertens

Leeuwen

Poel

2022

European Urology Open Science

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Financial Toxicity Among Patients with Prostate, Bladder, and Kidney Cancer: A Systematic Review and Call to Action

Cited by 42 publications

References 48 publications

Association of Race, Ethnicity, and Socioeconomic Status With Esthesioneuroblastoma Presentation, Treatment, and Survival

Association of Race, Ethnicity, and Socioeconomic Status With Esthesioneuroblastoma Presentation, Treatment, and Survival

Identifying priorities for research on financial risk protection to achieve universal health coverage: a scoping overview of reviews

Abandon the Label of Clinically Insignificant Prostate Cancer

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