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Patients with kidney cancer commonly have trouble affording medications, and often lack access to dental and mental healthcare. That was the conclusion of a recent study in .

Laura Bukavina, MD, MPH, of Case Western Reserve School of Medicine in Cleveland, and colleagues analyzed data from the CDC National Health Interview Survey, assessing the economic impact of cancer. The study included adult patients diagnosed with genitourinary cancer from 2008 to 2018, with approximately 8,000 with kidney cancer.

Of those, 30% reported trouble affording medication. In addition, 15% said they had postponed dental care and 5% said they could not afford mental healthcare.

"It is crucial to note that kidney cancer survivors, especially in the younger cohort, generally displayed a more pronounced inclination toward multiple financial challenges," the researchers wrote. "These findings collectively underscore the critical need for interventions targeting the financial aspects of cancer care to mitigate its broad spectrum impact on patient health outcomes."

In the following interview, Bukavina, who is translational science lead in GU Oncology at Cleveland Clinic Lerner College of Medicine, discussed the implications of the findings and possible interventions.

Your study assessed financial toxicity and financial distress. What is the difference?

Bukavina: Financial toxicity refers to the direct, measurable cost of healthcare to the patient, which includes things like out-of-pocket cost, income loss, or depletion of savings. Financial distress is a subjective experience of hardship felt by patients; this can include emotional and psychological stress as the result of financial toxicity.

Financial distress focuses more on the challenges within mental, emotional response to financial toxicity, and decisions patients must make due to the financial toxicity.

Why is access to mental healthcare important for patients with cancer?

Bukavina: Multiple reasons really, from the diagnosis through treatment and long after. Mental health is vital to our cancer patients. It helps with emotional support and coping with diagnosis and treatment, providing the tools and support needed to cope. It is clear it also improves the quality of life of patients and treatment adherence to therapy.

We also know that mental health is strongly linked to physical health, which in turn can improve recovery and lead to overall better outcomes. As our patients deal with the diagnosis and challenges of treatment, this is also equally difficult for the caregivers, such as family or friends, and mental health can provide tools to the caregivers as well, as we know dynamics often change with new diagnosis.

How can financial distress impact patients with kidney cancer specifically?

Bukavina: Kidney cancer survivors, especially those over 65, were more likely to forgo care. Additionally, both younger and older survivors faced greater difficulty affording prescription medications. Younger patients, in particular, reported nearly double the risk of being unable to afford mental health services.

How can physicians help address financial toxicity/distress for their patients with kidney cancer?

Bukavina: Collectively, physicians can further strengthen their advocacy by pushing for the inclusion of comprehensive services, such as mental healthcare and survivorship support, in clinical guidelines for surveillance and treatment of genitourinary cancers.

Individually, physicians can also address these barriers by working within their institutions to designate services or establish pathways where mental health support is integrated into the standard recovery process for cancer survivors. Just as wound care for ostomies, physical therapy, and nutritional support are routinely provided as essential components of recovery, mental health services should be similarly included.

What non-physician interventions for financial toxicity/distress have been proposed?

Bukavina: Several, such as financial navigator programs that help patients understand costs and access financial resources, including charitable programs.

Social work services collaborate closely with financial navigators to assist patients in securing benefits (such as mental health support) and coverage. Patient advocacy and peer support groups are incredible resources, offering practical advice and knowledge from individuals who have faced similar situations. For instance, organizations like the and the are excellent resources for our patients.

Read the study here and expert commentary about it here.