The costs and inequities of precision medicine for patients with prostate cancer: A call to action

• Published in: Urologic oncology 2023-09, Vol.41 (9), p.369-375
• Main Authors: Ragavan, Meera V., Borno, Hala T.
• Format: Article
• Language: English
• Subjects: Clinical trials; Disparities; Financial toxicity; Precision oncology; Prostate cancer
• ISSN: 1078-1439; 1873-2496
• DOI: 10.1016/j.urolonc.2023.04.012

•Financial toxicity is a prevalent problem for men diagnosed with prostate cancer and has the potential to widen existing racial/ethnic disparities in screening, diagnosis, treatment, trial enrollment, and survivorship.•Out of pocket costs for local therapies, systemic therapies, trial-related activities, and supportive care medications may prohibit equitable access.•Disparities have been shown to be eliminated for men treated in equal access systems, suggestive that inequitable outcomes are driven primarily by structural factors rather than biological factors.•Improvements in public insurance coverage of screening and precision medicine, partnerships with community practices to enhance trial enrollment, and patient navigators may help mitigate financial barriers to prostate cancer care and mitigate existing disparities. Financial toxicity is a growing problem in the delivery of cancer care and contributes to inequities in outcomes across the cancer care continuum. Racial/ethnic inequities in prostate cancer, the most common cancer diagnosed in men, are well described, and threaten to widen in the era of precision oncology given the numerous structural barriers to accessing novel diagnostic studies and treatments, particularly for Black men. Gaps in insurance coverage and cost sharing are 2 such structural barriers that can perpetuate inequities in screening, diagnostic workup, guideline-concordant treatment, symptom management, survivorship, and access to clinical trials. Mitigating these barriers will be key to achieving equity in prostate cancer care, and will require a multi-pronged approach from policymakers, health systems, and individual providers. This narrative review will describe the current state of financial toxicity in prostate cancer care and its role in perpetuating racial inequities in the era of precision oncology.