Routine conversations about costs can address the financial toxicity associated with new technologies used in the diagnosis and treatment of prostate cancer.
“The management of prostate cancer has evolved dramatically over the last two decades with the availability of new technologies in treatment and imaging,” Avinash Maganty, MD, MS, and Brent K. Hollenbeck, MD, MS, wrote. “New treatment and delivery technologies for early-stage prostate cancer—robotics, proton beam radiation, and hypofractionation—introduced early in the 2000s disseminated rapidly with the promise of lower treatment-related morbidity. Prostate MRI and [prostate-specific membrane antigen (PSMA)] PET imaging are revolutionizing the diagnostic space.”
However, even though these new diagnostic and therapeutic technologies are more costly than prior modalities, the selection of tests and treatments based on benefit, adverse-effects profile, and physician recommendations disregards the costs incurred by patients, the authors noted. Dr. Maganty and Dr. Hollenbeck published the commentary in Urologic Oncology: Seminars and Original Investigations.
Physician’s Weekly spoke with Dr. Maganty to learn more about what motivated the commentary and what he hopes clinicians can take away from it.
PW: Why assess financial toxicities associated with newer technology in prostate cancer?
Dr. Maganty: Prostate cancer typically progresses slowly, with treatment benefits often realized over a timeframe of more than 10 years. While they have the potential to reduce treatment-related morbidity, newer technologies may not always provide additional benefit to the patient, and they often come with higher costs. The associated financial burden can lead to financial toxicity, which negatively impacts overall health and QOL. Therefore, it’s critical to assess these costs and balance them with potential clinical benefits to avoid unnecessary treatment and subsequent financial toxicity.
Which new technologies are driving the higher costs?
Several new technologies are likely contributing to the higher cost of managing prostate cancer. While the cost of robotics and advanced radiation treatments like hypofractionation and proton therapy have decreased over time, they were initially quite expensive; certain technologies, however, like proton therapy, remain costly. New diagnostic tests such as PSMA PET and genomic testing, as well as targeted therapies, have entered the market and can impose a substantial financial burden on patients. The challenge lies in identifying which patients would derive the most benefit from these new diagnostic tests or treatments.
How do these technologies influence access to treatment?
I think these new technologies present a double-edged sword. On the one hand, minimally invasive approaches, for example, may extend a treatment option to those who wouldn’t have tolerated a more invasive treatment. On the other hand, the higher costs associated with new therapies and tests may put them out of reach for some patients. This creates a complex balancing act that needs to be considered in the shared decision-making process between physicians and patients, taking into account each patient’s individual preferences and goals.
How can providers discuss financial toxicity at various stages of treatment?
The first step is for providers to initiate open conversations about financial toxicity, an aspect that is often overlooked in current practice. A key strategy involves engaging in a shared decision-making process from the outset, considering each patient’s preferences and the hardships they may face. This approach would also require increased transparency about costs, which we still struggle to obtain. Nonetheless, a proactive approach to addressing financial toxicity can provide patients with additional information to navigate the complex landscape of new treatments and technologies.
What additional research is needed in this area?
I think further research in two primary areas could mitigate the impact of financial toxicities associated with newer treatments. First, as technologies emerge, we need more research to identify the specific patient populations that would benefit the most from them. Indiscriminate use can lead to unnecessary testing, treatment, and avoidable financial toxicity. Second, improved methods for measuring and addressing financial toxicity are required, which also involves developing effective measures and strategies for integrating them into clinical practice. This would enable a more comprehensive understanding of the financial burden faced by patients and a mechanism to better support them throughout their treatment.
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