Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
Department of Urology, Massachusetts General Hospital, Boston, Massachusetts.
Urol Pract. 2023 Sep;10(5):459-466. doi: 10.1097/UPJ.0000000000000417. Epub 2023 Jul 5.
Despite increasing attention to financial toxicity associated with prostate cancer, national rates of subjective and objective financial toxicity have not been well characterized, and it remains unknown which prostate cancer survivors are at highest risk for undue financial burden.
Men with a history of prostate cancer were identified from the Medical Expenditure Panel Survey. The proportion of men reporting catastrophic health care expenditures (out-of-pocket spending >10% of income) and other measures of financial toxicity were assessed. Multivariable logistic regression was used to identify independent predictors of financial toxicity.
Of a weighted estimate of 2,349,532 men with a history of prostate cancer, 13.5% reported catastrophic health care expenditures, 16% reported subjective worry about ability to pay medical bills, and 15% reported work changes due to their cancer diagnosis. Significant predictors of catastrophic expenditures included private insurance (OR 4.62, 95% CI 1.29-16.49) and medical comorbidities (OR 1.38, 95% CI 1.05-1.82), while high income was protective (>400% vs <100% federal poverty level, OR 0.06, 95% CI 0.02-0.19). Each year of older age was associated with decreased odds of subjective worry about medical bills. Only 12% of men reported their doctor discussed the costs of care in detail.
Nearly 1 in 7 prostate cancer survivors experience catastrophic health care expenditures, and a larger proportion report subjective manifestations of financial toxicity. Many men report their physicians did not address the financial side effects of treatment. These results highlight the patient characteristics associated with this important side effect of prostate cancer care.
尽管人们越来越关注前列腺癌相关的财务毒性，但尚未很好地描述全国范围内主观和客观财务毒性的发生率，也不知道哪些前列腺癌幸存者面临过高的财务负担风险最大。
从医疗支出调查中确定有前列腺癌病史的男性。评估报告灾难性医疗支出（自付支出超过收入的 10%）和其他财务毒性指标的男性比例。使用多变量逻辑回归来确定财务毒性的独立预测因素。
在一项 2349532 名有前列腺癌病史的男性的加权估计中，13.5%报告了灾难性的医疗支出，16%报告了对支付医疗费用能力的主观担忧，15%报告了因癌症诊断而改变工作。灾难性支出的显著预测因素包括私人保险（OR 4.62，95%CI 1.29-16.49）和医疗合并症（OR 1.38，95%CI 1.05-1.82），而高收入则具有保护作用（>400% vs <100%联邦贫困线，OR 0.06，95%CI 0.02-0.19）。年龄每增加一年，对医疗费用的主观担忧的可能性就会降低。只有 12%的男性报告他们的医生详细讨论了治疗费用。
近 1/7 的前列腺癌幸存者经历了灾难性的医疗支出，更多的人报告了主观的财务毒性表现。许多男性报告说他们的医生没有解决治疗的财务副作用。这些结果突出了与前列腺癌护理这一重要副作用相关的患者特征。
