Catto - Figure 12
Financial toxicity
FIG. 12: A number of data sets have shown that surveillance is a toxic financial situation for patients. Figure 12 shows results from a 4-year interval in the Surveillance, Epidemiology, and End Results (SEER) Program–Medicare-linked database.[14] Among almost 7000 patients, 60% did not have complete surveillance, meaning that only 40% of patients had complete surveillance, stratified by care pathways. The primary reasons for lack of surveillance were the huge costs and financial toxicity. Patients were less likely to have complete follow-up and surveillance if they were older, lived in an urban environment, were black, or had low-risk cancer.
The right half of the Figure shows data from a later report, looking at over 20,000 SEER-Medicaid patients whose care was delivered by 940 clinicians.[15] Again there was large variability in cost in the management of the disease, with much of this burden coming from the follow-up of patients. Clinicians have different risk criteria for managing and following patients, and the result was a 3-fold difference in expenditure per patient, ranging from $2800 for low-treatment intensity providers to $7100 for high-treatment intensity providers. Of note, however, the difference in costs was associated with no difference in benefit or survival.
References
Schrag D, Hsieh LJ, Rabbani F, et al. Adherence to surveillance among patients with superficial bladder cancer. J Natl Cancer Inst. 2003;95:588−97 https://doi.org/10.1093/jnci/95.8.588
Hollenbeck B, Ye Z, Dunn RL, et al. Provider treatment intensity and outcomes for patients with early-stage bladder cancer. J Natl Cancer Inst. 2009;101:571−80 https://doi.org/10.1093/jnci/djp039