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JU INSIGHT: Financial Toxicity After Robot-assisted Radical Prostatectomy and Its Relation With Oncologic, Functional Outcomes

By: Oktay Özman, MD; Corinne N. Tillier, PhD Candidate; Erik van Muilekom; Lonneke V. van de Poll-Franse, PhD; Henk G. van der Poel, MD, PhD | Posted on: 01 Nov 2022

Özman O, Tillier CN, van Muilekom E, van de Poll-Franse LV, van der Poel HG. Financial toxicity after robot-assisted radical prostatectomy and its relation with oncologic, functional outcomes. J Urol. 2022;208(5):978-986.

Study Need and Importance

Robotic systems articulating our daily surgical practice is one of the groundbreaking developments. Technological developments implemented in medical care bring along financial burden on governments, health systems and, after all, patients suffering from diseases, especially cancer. Financial toxicity (FT) faced by cancer survivors is a common but underspoken consequence of technology-dependent, high cost, and long-lasting management modalities of cancer often related to disabilities and changes in quality of life.

What We Found

FT frequency was 8.3% (95% CI 7.0-9.8) among patients who underwent robot-assisted radical prostatectomy. In The Netherlands, radical prostatectomy is mostly performed robot-assisted without out-of-pocket payments by patients. Nevertheless, still nonnegligible numbers of patients had FT, defined as any financial difficulty caused by prostate cancer-related physical condition or treatments as measured with the financial impact scale of the European Organisation for Research and Treatment of Cancer quality of life questionnaire (question 28). Men with FT were younger, not retired, and more frequently bothered by postoperative symptom burden. Voiding symptoms such as urinary incontinence rather than erectile dysfunction were especially associated with FT (see Figure).

Figure. Patient-reported incontinence measure changes during follow-up for the groups. FT indicates financial toxicity; ICIQ-SF, International Consultation on Incontinence Questionnaire—Short Form.

Limitations

The subjective nature of outcome measurement method and response rate to questionnaires were limitations. In addition, our retrospective analysis lacks data on education level and earning levels of patients.

Interpretations for Patient Care

We depict that if robot-assisted radical prostatectomy is covered by health insurance and is performed in high-volume referal cancer centers by experienced robotic surgeons, FT incidence is relatively low among cancer survivors. In particular, younger men with urinary incontinence experienced FT. Medical caregivers should be aware of the risk factors that increase financial disturbances for patients during the management of prostate cancer.

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