The Anti-Androgen Transfer

Abstract

Objectives: Financial and nonfinancial barriers affect the care of prostate cancer patients. In this study, we evaluated whether financial considerations were a primary reason for lower income veterans with prostate cancer to transfer their care to Veterans Affairs (VA) Hospitals, and if so, which aspects of medical care were most affected by these considerations. Materials and Methods: Interviews with 106 veterans with prostate cancer were undertaken after the transfer of their care to the VA medical system. Respondents provided information about the primary reasons they shifted their care. Results: Although 64.2% of the patients had private health insurance before their initial visit to the VA, only 26.4% retained their private health insurance at the time of the interview, and 53.8 % transferred their entire medical care to the VA after the diagnosis of prostate cancer. Reasons for transferring care to the VA included the costs of oral anti-androgen therapy (34.9%), copayment costs for physician visits (30.2%), a feeling that medical care would be better in the VA system (26.4%), and copayment costs of luteinizing hormone-releasing hormone analogs (8.5%). Reasons for transfer varied with stage of disease at diagnosis (p < 0.05). The most common reasons for transfer were anti-androgen therapy costs among metastatic patients and, among patients with localized cancer, physician copayments and a feeling that care would be of higher quality in the VA system. Conclusions: Our findings suggest that there is a phenomenon, termed the “anti-androgen transfer,” that leads veterans with metastatic prostate cancer to transfer to the VA setting. The enactment of a comprehensive pharmaceutical benefit to the Medicare program will affect transfers of metastatic prostate cancer patients to the VA medical system.