Out-of-pocket expenses and treatment choice for men with prostate cancer

Objective: To describe the knowledge of, and attitudes toward, out-of-pocket expenses (OOPE) associated with prostate cancer treatment and the influence of OOPE on the treatment choices of patients with prostate cancer.

Materials and methods: We undertook a qualitative research study for which we recruited patients with clinically localized prostate cancer. Patients answered a series of open-ended questions during a semistructured interview and completed a questionnaire about the physician's role in discussing OOPE, the burden of OOPE, the effect of OOPE on treatment decisions, and previous knowledge of OOPE.

Results: A total of 41 (26 white and 15 black) eligible patients were enrolled from the urology and radiation oncology practices of the University of Pennsylvania. Qualitative assessment revealed 5 major themes: (a) "my insurance takes care of it"; (b) "health is more important than cost"; (c) "I did not look into it"; (d) "I cannot afford it but would have chosen the same treatment"; and (e) "It is not my doctor's business." Most patients (38 of 41, 93%) reported that they would not have chosen a different treatment even if they had known the actual OOPE of their treatment. Patients who reported feeling burdened by OOPE were socioeconomically heterogeneous, and their treatment choices remained unaffected. Only 2 patients stated they knew "a lot" about the likely OOPE for different prostate cancer treatments before choosing their treatment.

Conclusion: Among insured patients with prostate cancer treated at a large academic medical center, few had knowledge of OOPE before making treatment choices.