Financial Toxicity and Its Association With Prostate and Colon Cancer Screening

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  • 1 Pediatrics Department, University of Toledo College of Medicine and Life Sciences, Toledo, Ohio;
  • | 2 The Bob Shapell School of Social Work, Tel-Aviv University, Tel-Aviv, Israel;
  • | 3 Performing Arts Medicine Department, Shenandoah University, Winchester, Virginia;
  • | 4 USC Norris Cancer Center, Keck Medical Center, University of Southern California, Los Angeles, California;
  • | 5 Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts;
  • | 6 Memorial Sloan Kettering Cancer Center, New York, New York;
  • | 7 Department of Urology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania; and
  • | 8 Urology Department, and
  • | 9 Hematology/Oncology Department, State University of New York Upstate Medical University, Syracuse, New York.

Background: The term “financial toxicity” or “hardship” is a patient-reported outcome that results from the material costs of cancer care, the psychological impacts of these costs, and the coping strategies that patients use to deal with the strain that includes delaying or forgoing care. However, little is known about the impact of financial toxicity on cancer screening. We examined the effects of financial toxicity on the use of screening tests for prostate and colon cancer. We hypothesized that greater financial hardship would show an association with decreased prevalence of cancer screening. Methods: This cross-sectional survey–based US study included men and women aged ≥50 years from the National Health Interview Survey database from January through December 2018. A financial hardship score (FHS) between 0 and 10 was formulated by summarizing the responses from 10 financial toxicity dichotomic questions (yes or no), with a higher score associated with greater financial hardship. Primary outcomes were self-reported occurrence of prostate-specific antigen (PSA) blood testing and colonoscopy for prostate and colon cancer screening, respectively. Results: Overall, 13,439 individual responses were collected. A total of 9,277 (69.03%) people had undergone colonoscopies, and 3,455 (70.94%) men had a PSA test. White, married, working men were more likely to undergo PSA testing and colonoscopy. Individuals who had not had a PSA test or colonoscopy had higher mean FHSs than those who underwent these tests (0.70 and 0.79 vs 0.47 and 0.61, respectively; P≤.001 for both). Multivariable logistic regression models demonstrated that a higher FHS was associated with a decreased odds ratio for having a PSA test (0.916; 95% CI, 0.867–0.967; P=.002) and colonoscopy (0.969; 95% CI, 0.941–0.998; P=.039). Conclusions: Greater financial hardship is suggested to be associated with a decreased probability of having prostate and colon cancer screening. Healthcare professionals should be aware that financial toxicity can impact not only cancer treatment but also cancer screening.

Submitted February 3, 2022; final revision received May 22, 2022; accepted for publication May 23, 2022.

Author contributions: Study concept and design: Goldberg. Data collection and analysis: Herriges, Goldberg. Writing—original draft: Herriges, Peck, Goldberg. Writing—review and editing: Shenhav-Goldberg, Peck, Bhanvadia, Morgans, Chino, Chandrasekar, Shapiro, Jacob, Basnet, Bratslavsky, Goldberg.

Disclosures: Dr. Morgans has disclosed receiving grant/research support from Astellas Pharma US, Inc., Bayer HealthCare, Myovant Sciences, Pfizer Inc., sanofi-aventis US, and Seagen Inc.; serving as a principal investigator for Alliance Pharma Inc., Bayer HealthCare, Myovant Sciences, and Pfizer Inc; serving as a advisory board member for AAA Pharmaceutical, Inc., Astellas Pharma US, AstraZeneca Pharmnaceuticals LP, Bayer HealthCare, Dendreon Corporation, Lantheus Holdings, Inc., Myovant Sciences, Merck & Co., Inc., Myriad Genetic Laboratories, Inc., Pfizer Inc., Seagen Inc., and sanofi-aventis US; and serving as a consultant for AAA Pharmaceutical, Inc., Astellas Pharma US, AstraZeneca Pharmaceuticals LP, Bayer HealthCare, Lantheus Holdings, Inc., Myovant Sciences, Novartis Pharmaceuticals Corporation, Pfizer Inc., and sanofi-aventis US. The remaining authors have disclosed that they have not received any financial consideration from any person or organization to support the preparation, analysis, results, or discussion of this article.

Funding: Dr. Chino has disclosed receiving research support from the NCI of the NIH (award P30 CA008748).

Correspondence: Hanan Goldberg, MD, MSc, Urology Department, State University of New York Upstate Medical University, 750 East Adams Street, Syracuse, NY 13210. Email: gohanan@gmail.com

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