Financial Toxicity After Robot-Assisted Radical Prostatectomy and Its Relation with Oncologic, Functional Outcomes

No AccessJournal of UrologyAdult Urology1 Nov 2022Financial Toxicity After Robot-Assisted Radical Prostatectomy and Its Relation with Oncologic, Functional OutcomesThis article is commented on by the following:Editorial Comment Oktay Özman, Corinne N. Tillier, Erik van Muilekom, Lonneke V. van de Poll-Franse, and Henk G. van der Poel Oktay ÖzmanOktay Özman *Correspondence: The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CXAmsterdam telephone: +31 6 23 03 54 02; email: E-mail Address: [email protected]; E-mail Address: [email protected] https://orcid.org/0000-0003-2499-8947 Department of Urology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands , Corinne N. TillierCorinne N. Tillier Department of Urology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands , Erik van MuilekomErik van Muilekom Department of Urology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands , Lonneke V. van de Poll-FranseLonneke V. van de Poll-Franse Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands , and Henk G. van der PoelHenk G. van der Poel Department of Urology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands View All Author Informationhttps://doi.org/10.1097/JU.0000000000002897AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: The aim of the study was to evaluate frequency of financial toxicity among patients who underwent robot-assisted radical prostatectomy for prostate cancer. Materials and Methods: Data of 1,479 robot-assisted radical prostatectomy patients between 2006-2021 reporting no financial toxicity in preoperative assessments were included retrospectively. Financial toxicity was measured with financial impact of European Organisation for Research and Treatment of Cancer-quality of life questionnaire-C30. Financial impact scores were collected preoperatively, 6, 12, 18, and 24 months after robot-assisted radical prostatectomy. Results: The frequency of financial toxicity was 8.3% (122/1379; 95% CI 7.0-9.8) at any point in time throughout 2 years of follow-up. Patients reporting financial toxicity (63 [58-68]) were significantly younger than patients who had no financial toxicity (65 [61-69]; P = .001). There was no statistically significant difference between financial toxicity+ and financial toxicity− groups in terms of salvage radiotherapy (P = .8) and positive surgical margin (P = .2) rates. In functional assessments, clinically significant International Prostate Symptom Score and International Consultation on Incontinence Questionnaire—Short Form score increase of financial toxicity+ patients (34% and 62%) were more frequent than financial toxicity− patients (23% and 47%; P = .004 and P = .002, respectively). In multivariable analysis, age at robot-assisted radical prostatectomy, International Prostate Symptom Score, International Consultation on Incontinence Questionnaire—Short Form, and quality of life scores were associated with financial toxicity (P < .001, OR 0.95 [95% CI 0.92-0.98]; P = .015, OR 2.4 [95% CI 1.2-4.7]; P = .032, OR 1.5 [95% CI 1.2-2.5]; P = .01, OR 0.09 [95% CI 0.01-0.57], respectively). Patients who underwent robot-assisted radical prostatectomy before retirement (≤65 years) had a 1.6-fold increased financial toxicity risk (P = .003, 95% CI 1.1-2.3). Conclusions: Financial toxicity after robot-assisted radical prostatectomy is low in mid-term follow-up. Patients who report urological symptoms after robot-assisted radical prostatectomy should also be evaluated for financial toxicity. Required measures against financial toxicity should be taken especially in the follow-up of younger cancer survivors. References 1. . Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021; 71(3):209-249. Crossref, Medline, Google Scholar 2. . Literature review of the burden of prostate cancer in Germany, France, the United Kingdom and Canada. BMC Urol. 2019; 19(1):19. Google Scholar 3. . Economic burden of cancer across the European Union: a population-based cost analysis. Lancet Oncol. 2013; 14(12):1165-1174. Google Scholar 4. . Treatment costs of prostate cancer in the first year after diagnosis: a short-term cost of illness study for France, Germany, Italy, Spain and the UK. BJU Int. 2010; 105(1):49-56. Google Scholar 5. . Health economic analysis of open and robot-assisted laparoscopic surgery for prostate cancer within the prospective multicentre LAPPRO trial. Eur Urol. 2018; 74(6):816-824. Google Scholar 6. . Variation in prostate surgery costs and outcomes in the USA: robot-assisted versus open radical prostatectomy. J Comp Eff Res. 2019; 8(3):143-155. Google Scholar 7. . Relationships between financial toxicity and symptom burden in cancer survivors: a systematic review. J Pain Symptom Manage. 2019; 57(3):646-660.e1. Google Scholar 8. . Association of financial strain with symptom burden and quality of life for patients with lung or colorectal cancer. J Clin Oncol. 2016; 34(15):1732-1740. Google Scholar 9. . Financial toxicity among patients with prostate, bladder, and kidney cancer: a systematic review and call to action. Eur Urol Oncol. 2021; 4(3):396-404. Google Scholar 10. . Thresholds for clinical importance were established to improve interpretation of the EORTC QLQ-C30 in clinical practice and research.J Clin Epidemiol. 2020; 118:1-8. Google Scholar 11. . The long-term relationship between a real change in prostate volume and a significant change in lower urinary tract symptom severity in population-based men: the Krimpen study. Eur Urol. 2008; 53(4):819-825. Google Scholar 12. . The minimum clinically important difference of the international consultation on incontinence questionnaires (ICIQ-UI SF and ICIQ-LUTSqol). Urology. 2019; 133:91-95. Google Scholar 13. . Minimal clinically important differences in the erectile function domain of the International Index of Erectile Function scale. Eur Urol. 2011; 60(5):1010-1016. Crossref, Medline, Google Scholar 14. . Financial distress in patients with advanced cancer. PLoS One. 2017; 12(5):e0176470. Google Scholar 15. . Pre-diagnosis employment status and financial circumstances predict cancer-related financial stress and strain among breast and prostate cancer survivors. Support Care Cancer. 2016; 24(2):699-709. Google Scholar 16. . A systematic review of financial toxicity among cancer survivors: we can't pay the co-pay. Patient. 2017; 10(3):295-309. Google Scholar 17. . The burden of out-of-pocket and indirect costs of prostate cancer. Prostate. 2010; 70(11):1255-1264. Google Scholar 18. . Patient-reported financial toxicity associated with contemporary treatment for localized prostate cancer. J Urol. 2021; 205(3):761-768. Link, Google Scholar 19. . Patient time and out-of-pocket costs for long-term prostate cancer survivors in Ontario, Canada. J Cancer Surviv. 2014; 8(1):9-20. Google Scholar 20. . Inequalities in financial distress, symptoms, and quality of life among patients with advanced cancer in France and the U.S. Oncologist. 2019; 24(8):1121-1127. Google Scholar 21. . Cost comparison of robotic, laparoscopic, and open radical prostatectomy for prostate cancer. Eur Urol. 2010; 57(3):453-458. Google Scholar 22. . Assessment of out-of-pocket costs for robotic cancer surgery in US adults. JAMA Netw Open. 2020; 3(1):e1919185. Crossref, Medline, Google Scholar 23. . The association of financial difficulties and out-of-pocket payments with health-related quality of life among breast, prostate and colorectal cancer patients. Acta Oncol. 2019; 58(7):1062-1068. Google Scholar 24. . Duration of sick leave after active surveillance, surgery or radiotherapy for localised prostate cancer: a nationwide cohort study. BMJ Open. 2020; 10(3):e032914. Google Scholar 25. . Workplace absenteeism amongst patients undergoing open vs. robotic radical prostatectomy, hysterectomy, and partial colectomy. Surg Endosc. 2021; 35(4):1644-1650. Google Scholar 26. . Prevalence, management and impact of urinary incontinence in the workplace. Occup Med (Lond). 2005; 55(7):552-557. Google Scholar 27. . Evaluation of fluorescent confocal microscopy for intraoperative analysis of prostate biopsy cores. Eur Urol Focus. 2021; 7(6):1254-1259. Google Scholar 28. . The development of a financial toxicity patient-reported outcome in cancer: the COST measure. Cancer. 2014; 120(20):3245-3253. Google Scholar Submitted December 16, 2021; accepted July 21, 2022; published October 7, 2022. Support: This study was supported by European Urological Scholarship Programme (EUSP). Conflict of Interest: None. Ethics Statement: This study received Institutional Review Board approval (IRB No. IRBd21-212). © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsRelated articlesJournal of Urology26 Aug 2022Editorial Comment Volume 208Issue 5November 2022Page: 978-986 PEER REVIEW REPORTS Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.Keywordsrobotic surgical procedurespatient reported outcome measuresprostatic neoplasmsquality of lifefinancial stressMetricsAuthor Information Oktay Özman Department of Urology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands *Correspondence: The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CXAmsterdam telephone: +31 6 23 03 54 02; email: E-mail Address: [email protected]; E-mail Address: [email protected] More articles by this author Corinne N. Tillier Department of Urology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands More articles by this author Erik van Muilekom Department of Urology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands More articles by this author Lonneke V. van de Poll-Franse Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands More articles by this author Henk G. van der Poel Department of Urology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands More articles by this author Expand All Submitted December 16, 2021; accepted July 21, 2022; published October 7, 2022. Support: This study was supported by European Urological Scholarship Programme (EUSP). Conflict of Interest: None. Ethics Statement: This study received Institutional Review Board approval (IRB No. IRBd21-212). 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