Oncologists May Need to Adjust Treatment to Address Financial Toxicity in RCC

Cristiane D. Bergerot, PhD

Health care systems in the United States and globally have been financially impacted by the COVID-19 pandemic, and now that the toxicity is entering oncology clinics, and affecting oncologists’ ability to treat and surveil some patients with renal cell carcinoma (RCC).

Research published in the World Journal of Urology based on an online survey shows that the financial impact of COVID-19 has been severe, especially for patients with RCC.

A total of 539 patients were surveyed from 14 countries. The study population was 39% male and 58% female, and of those patients, 23 did not feel in control of their financial situation, and only 8% were satisfied with their finances. The median comprehensive score for financial toxicity (COST) score was 21.5 (range 1-44), but the score differed when the investigators scored subgroups of patients with metastatic disease, as well gender, age, education, and income groups. 

Among patients with metastatic disease who were not yet treated with systemic therapy, the median COST score was 19.8 (range 2–41) compared to 23.9 (range 4-44) in patients with metastatic disease who were receiving systemic therapy. The low-COST groups included patients who were female, young patients, those living in urban areas, those with lower education, and those with lower income.

In the published paper, the investigators suggested better patient counseling and changing treatment and surveillance practices in an effort to offset the high cost of care for patients with RCC.

In an interview with Targeted Oncology™, Cristiane D. Bergerot, PhD, of the CETTRO Cancer Research Hospital, discussed factors contributing to financial toxicity in patients with RCC and how it impacts oncology care providers. She also touched upon how providers can help to improve the issue.

TARGETED ONCOLOGY™: Can you explain the cost measure that you used in this analysis? How was it used to conduct the RCC/financial toxicity study during the COVID-19 pandemic?

Bergerot: This is a validated measure for financial toxicity. It was developed to assess financial toxicity experienced by patients with cancer. So, this was one of the reasons that we decided to use this measure. And it is composed of 11 items that access financial toxicities in the Likert scale.

Prior to COVID-19, what financial setbacks were you already noticing with patients?

This study was done while I was working at City of Hope, and it was interesting to see because we already know that all patients have some financial hardship. However, in this study, patients have reported higher prevalence compared with previous data.

Did you notice any disparities between patients in this study?

In this study, we have noticed that being of female gender, being younger in age, living situation, having a lower level of education, and having lower income are characteristics that are associated with financial toxicity. But also, if patients present with metastatic disease or even if they have a risk of cancer recurrence or progression, they experienced more financial toxicity.

Can you give a key takeaway from your findings?

Patients with renal cell carcinoma experience heightened anxiety about increasing financial toxicity related to COVID-19. They're always also concerned that their money in savings or even retirement assets would not cover the cost of their treatments, or that they will lose their job. It also was interesting that a great proportion of patients do not feel like they are in control of their financial situation.

What conclusions were drawn from this analysis and what does this mean for oncologists treating patients with RCC as the pandemic continues?

Our data highlighted that there are patients facing severe financial impact of COVID-19. We also acknowledge the financial hardship and uncertainty related to future costs and the importance of providing counseling to patients with cancer as a part of the conversation during the pandemic. I would also highlight that the younger patients, woman, and those with lower income seems to be in the highest need of financial advising, and also need more support from our teams.

_Reference:

_{Staehler MD, Battle DJ, Bergerot CD, et al. COVID-19 and financial toxicity in patients with renal cell carcinoma. World J Urol. 2021; 39(7): 2559–2565. doi: 10.1007/s00345-020-03476-6}