Introduction

Bladder cancer is the sixth most common cancer in the United States, but the most expensive from diagnosis to death. Costly surveillance and treatment can lead to financial toxicity (FT), an adverse financial condition as a consequence of the treatment of a disease. The purpose of this study is to define the prevalence of FT among patients with bladder cancer and identify causes for delay in care.

Methods

Bladder cancer patients were identified from the University of North Carolina Health Registry/Cancer Survivorship Cohort (HR/CSC), which includes patient-reported data on FT. FT was defined at agreement with the following statement “you have to pay more for medical care than you can afford.� Demographic characteristics and factors leading to delayed care were compared using Fisher’s exact tests.

Results

144 bladder cancer patients were enrolled in HR/CSC, of which 138 completed the baseline questionnaire. Median age was 66.9 years. 75% were male, 89% were white, and 66% had less than a college degree. Half of patients had a stage of cT2 or higher. Thirty-three participants overall (24%) endorsed FT. Participants with FT were more likely to be younger, black, and have less than a college degree (p<0.01). Patients with non-invasive disease were more likely to report FT than those with invasive bladder cancer (15% vs. 30%; p=0.04). Patients who endorsed FT were more likely to report delaying care (19.8% vs. 35.1%) although this did not reach statistical significance (p=0.07). Patients reporting FT were more likely to delay care due to inability to take time off work (p=0.04) and inability to afford general expenses (p=0.04).

Conclusions

FT is a major concern among bladder cancer patients, with nearly 25% reporting that healthcare costs are more than they could afford. Younger patients were more likely to experience FT, which may be related to Medicare eligibility at age 65, which increases affordability of care. Higher rates of FT among non-invasive disease may reflect long-term, costly surveillance.

Funding

none