Department of Urology.
Duke-Margolis Center for Public Policy, Duke University.
Curr Opin Urol. 2024 Nov 1;34(6):484-488. doi: 10.1097/MOU.0000000000001218. Epub 2024 Aug 30.
Financial toxicity is a significant concern for many individuals with bladder cancer, which is, overall, the most expensive malignancy, per patient. Financial toxicity, defined as the harmful effects of treatment costs on an individual's quality of life, is associated with worse outcomes and decreased quality of life. Awareness of the objective and subjective factors that contribute to financial toxicity, and ways to mitigate their effects on patients, is essential to reduce the burden of bladder cancer care. This commentary aims to discuss the elements contributing to financial toxicity amongst bladder cancer patients, identify at-risk populations, and review current and potential strategies for mitigating financial burden.
Bladder cancer is becoming more expensive as the use of novel therapies increases. Early data suggest how some of these novel treatments or changes in treatment delivery may impact costs. Potential innovative strategies for cost reduction include blue light cystoscopy, intravesical gemcitabine-docetaxel rather than BCG for high-risk nonmuscle-invasive patients, home BCG therapy, and surveillance guideline optimization. However, there is still much work to be done on the potential impacts of these treatment on financial toxicity. While there is a paucity of data on treatment changes to reduce financial toxicity, and cost data can be hard to access, clinicians can still reduce the financial burden of cancer care. Awareness, financial toxicity screening, cost communication, and/or early referral to financial navigators or other similar resources have the potential to reduce financial burden. Despite mounting evidence, these tools/techniques are largely underutilized.
Many individuals with bladder cancer face significant financial toxicity, with the potential for this to worsen in the setting of rising treatment costs. Novel diagnostic and treatment modifications may reduce financial toxicity. However, awareness, screening, cost discussions, and utilization of financial navigators are tools/techniques that are currently available and should be used to reduce financial burden.
目的综述：膀胱癌患者普遍面临着高昂的治疗费用，经济毒性是一个重大问题。经济毒性是指治疗费用对个人生活质量的有害影响，与较差的预后和降低的生活质量有关。了解导致经济毒性的客观和主观因素，以及减轻其对患者影响的方法，对于减轻膀胱癌治疗负担至关重要。本述评旨在讨论膀胱癌患者经济毒性的形成因素，确定高危人群，并回顾当前和潜在的减轻经济负担的策略。
最新发现：随着新型治疗方法的应用，膀胱癌的治疗费用不断增加。早期数据表明，这些新型治疗方法或治疗方式的改变可能会如何影响成本。潜在的降低成本的创新策略包括使用蓝光膀胱镜检查、高危非肌层浸润性膀胱癌患者使用吉西他滨联合多西他赛代替卡介苗、家庭卡介苗治疗和优化监测指南。然而，这些治疗方法对经济毒性的潜在影响仍需要进一步研究。虽然关于降低经济毒性的治疗方法改变的数据很少，而且成本数据可能难以获取，但临床医生仍然可以减轻癌症治疗的经济负担。提高认识、经济毒性筛查、成本沟通和/或早期转介给财务顾问或其他类似资源有可能减轻经济负担。尽管证据越来越多，但这些工具/技术的应用仍远远不够。
总结：许多膀胱癌患者面临着严重的经济毒性，随着治疗费用的上升，这种情况有可能恶化。新型诊断和治疗方法的改变可能会降低经济毒性。然而，提高认识、筛查、成本讨论以及利用财务顾问是目前可用的减轻经济负担的工具/技术。
