Financial Toxicity and Its Association With Prostate and Colon Cancer Screening

Abstract

Background: The term “financial toxicity” or “hardship” is a patient-reported outcome that results from the material costs of cancer care, the psychological impacts of these costs, and the coping strategies that patients use to deal with the strain that includes delaying or forgoing care. However, little is known about the impact of financial toxicity on cancer screening. We examined the effects of financial toxicity on the use of screening tests for prostate and colon cancer. We hypothesized that greater financial hardship would show an association with decreased prevalence of cancer screening. Methods: This cross-sectional survey–based US study included men and women aged ≥50 years from the National Health Interview Survey database from January through December 2018. A financial hardship score (FHS) between 0 and 10 was formulated by summarizing the responses from 10 financial toxicity dichotomic questions (yes or no), with a higher score associated with greater financial hardship. Primary outcomes were self-reported occurrence of prostate-specific antigen (PSA) blood testing and colonoscopy for prostate and colon cancer screening, respectively. Results: Overall, 13,439 individual responses were collected. A total of 9,277 (69.03%) people had undergone colonoscopies, and 3,455 (70.94%) men had a PSA test. White, married, working men were more likely to undergo PSA testing and colonoscopy. Individuals who had not had a PSA test or colonoscopy had higher mean FHSs than those who underwent these tests (0.70 and 0.79 vs 0.47 and 0.61, respectively; P≤.001 for both). Multivariable logistic regression models demonstrated that a higher FHS was associated with a decreased odds ratio for having a PSA test (0.916; 95% CI, 0.867–0.967; P=.002) and colonoscopy (0.969; 95% CI, 0.941–0.998; P=.039). Conclusions: Greater financial hardship is suggested to be associated with a decreased probability of having prostate and colon cancer screening. Healthcare professionals should be aware that financial toxicity can impact not only cancer treatment but also cancer screening.

Financial Toxicity: A Barrier to Achieving Health Equity in Cancer Care

“…Financial hardship and financial toxicity present substantial barriers to patients’ having a fair and just opportunity to achieve the best health outcomes possible as they try to prevent, find, treat, and survive cancer, as well as implementation challenges to the cancer care delivery system. Such challenges are also present for cancer screening, as research suggests that those experiencing financial hardship are less likely to get prostate and colorectal cancer screenings [ 18 ]. Thus, changes to care delivery will need to be put in place to screen patients for financial hardship before entering cancer care; patients will need to be navigated to the appropriate resources to address the material, psychological, and behavioral components of financial hardship (preferably multiple times as they navigate care); and patients must also be connected to those resources and followed up to ensure that the resources addressed their financial hardship.…”

Colorectal cancer screening future modalities among Saudi population: national questioner

“…It appears that more perceived burdens is connected with a role in limiting of receiving colon cancer screening. Budgetary damage can affect both cancer therapy and cancer screening, and healthcare providers ought to be cautious of this (15). Successful focal immunochemical test is connected with heightened incidence of rheumatoid arthritis in the normal community, verifying that gut mucosal abnormalities are linked to the onset of systemic lupus erythematosus, rheumatoid arthritis, and psoriatic arthritis.…”

No Money, Mo’ Problems: Financial Toxicity in the Realm of Cancer Screening

“…This comparison is similarly found in prostate cancer, for which the initial PSA screening test is low-cost, with the possibility of additional expenses for further workup (eg, urologic consultation with transrectal ultrasound-guided biopsy). Although Herriges et al 3 did not specifically analyze FOBT/FIT in their financial hardship analysis, other studies have shown that FIT (a cheaper alternative), followed by colonoscopy if the FIT results are positive, increased patient compliance, meeting goals of .80% screening adherence after implementation of a comprehensive approach to screening. 4 Although higher-volume programs can decrease the cost per person for screening colonoscopies, FOBT/FIT followed by diagnostic colonoscopy as needed is cost-effective compared with universal screening colonoscopies ($1,291 vs $3,153).…”

“…Herriges et al 3 have shown that financial toxicity not only is predominant in cancer care delivery but also impacts cancer screening. The causes of low screening rates are multifactorial; however, financial toxicity unmistakably plays a significant role.…”