COVID-19 and financial toxicity in patients with renal cell carcinoma
By
Michael D. Staehler
Dena J. Battle
Cristiane D. Bergerot
Sumanta Kumar Pal
David F. Penson
October 22, 2020
Clinical Scorecard: The Impact of COVID-19 on Financial Burdens in Renal Cell Carcinoma Patients
At a Glance
Category Detail
Condition Renal Cell Carcinoma Key Mechanisms COVID-19 pandemic increases financial toxicity and anxiety among RCC patients; advances in RCC care coincide with increased patient cost-sharing Target Population Patients with renal cell carcinoma, including metastatic and localized disease Care Setting Academic centers, regional centers, private practices
Key Highlights
Majority of RCC patients expect COVID-19 to cause medical, behavioral, psychological, and financial hardship. Lower income patients (<$50,000) report significantly higher anxiety about financial hardship compared to higher income patients. Median financial toxicity (COST) score was 21.5; metastatic patients not on systemic therapy had the worst financial toxicity. Guideline-Based Recommendations
Diagnosis
Assess patient anxiety related to COVID-19 and cancer progression using validated scales. Evaluate financial toxicity using the COST patient-reported outcome measure. Management
Implement strategies to reduce patient financial burden during COVID-19, especially for lower income groups. Consider patient socioeconomic status when planning RCC treatment and supportive care. Monitoring & Follow-up
Regularly monitor patient distress, financial hardship, and behavioral expectations during treatment. Track changes in financial toxicity scores over time to identify patients at risk. Risks
Increased financial toxicity may lead to reduced treatment satisfaction and increased anxiety. Job and income loss concerns are prevalent and may impact treatment adherence. Patient & Prescribing Data
539 RCC patients surveyed; 52% metastatic, 35% post-surgery localized disease, 5% awaiting surgery
Patients on oral systemic therapy reported higher COST scores indicating less financial toxicity compared to metastatic patients not yet on systemic therapy.
Clinical Best Practices
Incorporate financial toxicity screening into routine RCC patient assessments. Provide targeted financial counseling and support resources, especially for lower income patients. Adapt cancer care delivery to minimize COVID-19 exposure while maintaining treatment efficacy. Engage multidisciplinary teams including psychologists and patient advocates to address anxiety and distress. References
