Open Access

ARTICLE

The financial impact of cancer care on renal cancer patients

Doreen A. Ezeife¹, Brendon Josh Morganstein², Steven Yip¹, Malcolm Ryan², Jennifer H. Law², Amy Yimin Guan³, Lisa W. Le³, Aaron R. Hansen², Adrian Sacher², Georg A. Bjarnason⁴, Mark K. Doherty⁴, Natasha B. Leighl²

1 Tom Baker Cancer Centre, Calgary, Alberta, Canada
2 Princess Margaret Cancer Centre/University Health Network, Toronto, Ontario, Canada
3 Department of Biostatistics, Princess Margaret Cancer Centre/University Health Network, Toronto, Ontario, Canada
4 Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada
Address correspondence to Dr. Doreen A. Ezeife, Tom Baker Cancer Centre, 1331 29 St NW, Calgary, AB T2N 4N2 Canada

Canadian Journal of Urology 2021, 28(4), 10762-10767.

Abstract

Introduction: Advances in novel treatment options may render renal cell cancer (RCC) patients susceptible to the financial toxicity (FT) of cancer treatment, and the factors associated with FT are unknown.
Materials and methods: Eligible patients were ≥ 18 years old and had a diagnosis of stage IV RCC for at least 3 months. Patients were recruited from Princess Margaret Cancer Centre and Sunnybrook Odette Cancer Centre (Toronto, Canada). FT was assessed using the validated Comprehensive Score for Financial Toxicity (COST) instrument, a 12-question survey scored from 0-44, with lower scores reflecting worse FT. Patient and treatment characteristics, out-of-pocket costs (OOP), and private insurance coverage (PIC) were collected. Factors associated with worse FT (COST score < 21) were determined.
Results: Sixty-five patients were approached and 80% agreed to participate (n = 52). The median age was 62 (44-88); 20% were female (n = 10); 43% were age ≥ 65 (n = 22); 63% were Caucasian (n = 31). Median COST score was 20.5 (3-44). Factors associated with worse FT were age < 65 (OR 9.5, p = 0.007), high OOP (OR 4.4, p = 0.04), and receiving treatment off clinical trial (in comparison to being on surveillance or on clinical trial) (OR 5.9, p = 0.03), when adjusting for other factors in multivariable logistic regression. However, there was no correlation between annual income or PIC and FT.
Conclusion: Financial toxicity in the RCC population is more significant in younger patients and those on treatment outside of a clinical trial. Financial aid should be offered to these at-risk patients to optimize adherence to life-prolonging RCC treatments.

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