Patient-Reported Financial Toxicity Following Definitive Radiation Therapy for Localized Prostate Cancer

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<h3>Purpose/Objective(s)</h3> Financial toxicity is increasingly recognized but poorly characterized in the context of prostate cancer. The purpose of this study was to evaluate the magnitude of financial toxicity experienced by men with localized prostate cancer treated with definitive radiation therapy (RT) at a comprehensive cancer center. <h3>Materials/Methods</h3> Between 5/2020 and 10/2020, 1233 prostate cancer patients at our institution completed a one-time survey, which included the COmprehensive Score for financial Toxicity (COST) instrument, estimates of out-of-pocket (OOP) expenditures, and beliefs regarding costs of treatment. For this study, we analyzed the 373 men who received definitive RT within the prior 4-26 months. The COST scores (ranging from 0-44 with lower scores corresponding to higher financial toxicity) and other survey responses were stratified by RT modality (SBRT, moderate hypofractionation, brachytherapy alone, or combination EBRT with brachytherapy). <h3>Results</h3> Patients were primarily white (85%), English-speaking (99%), married (79%), employed/retired (94%), insured (100%), and reported annual household incomes > $50k (86%). Median (quartile) COST score for all patients was 33 (26, 38) with 5.3% qualifying their prostate cancer associated financial hardship as ‘quite a bit' or ‘very much'. Fifty-six (15%) respondents report an estimated OOP cost > $5,000 and 33 respondents (9.5%) reported spending above 20% of annual income. Results by RT modality are presented in Table 1. Patients undergoing SBRT had higher COST scores (i.e., lower financial toxicity) than the other RT types. There is some evidence of differences in COST score by RT type, however this did not meet conventional levels of significance (Kruskal-Wallis <i>P</i>-value 0.088). Most patients (82%) reported giving little or no consideration to potential costs prior to making a treatment decision, yet the majority (79%) felt that potential OOP costs should be communicated to a patient. <h3>Conclusion</h3> Although the overall degree of financial toxicity in this cohort of patients with above average income and insurance coverage was low, most patients would want to discuss potential costs before treatment and 5-10% reported high levels of distress. Further analyses are planned to identify independent predictors for severe toxicity in order to inform strategies aimed to mitigate risk.