Scientific Objective and Rationale: Prostate cancer has been shown to pose the highest financial burden and stress among the seven most common cancers. Prostate cancer affects older men and their families who often are living on fixed incomes and find treatment-related side effects magnified because overall quality of life has deteriorated due to aging. In addition, caregivers are older and hence their quality of life is impacted to a greater extent and adult children often have to help. Even if cured of localized prostate cancer, the side effects of incontinence and impotence can result in significant impact on quality of life and cost for diapers and erectile function aids, both of which are reimbursed rarely. Death from prostate cancer has become much more expensive with the Food and Drug Administration (FDA) approval of seven new treatments, all of which extend overall survival. These treatments cause side effects that further impair quality of life and are very expensive. Many are covered only partially by Medicare or insurance, and the trend is toward increasingly large co-pays to offset the costs of these medications that may be as high as $8,000 a month. The ability of a prostate cancer patient and his family to absorb these quality-of-life and financial costs differs by age, socioeconomic status, quality of insurance, ability to interact effectively with the American healthcare system, and caregiver availability. African Americans, compared to Caucasian Americans, have been reported to have less financial reserve and poorer quality of interaction with the American healthcare system, although their religiosity and spirituality may make them better caregivers. However, a comprehensive literature review revealed a dearth of literature on racial differences in the impact of financial burden and stress on men with prostate cancer and their families. Studies of financial burden and stress and caregiver strain have been conducted in cohorts that consist almost entirely of Caucasian Americans. Only one study contained a significant number of African Americans (n=111); African Americans exhibited higher levels of financial stress when caring for patients dying from a variety of causes. Since treatment of advanced prostate cancer has become increasingly expensive and African Americans suffer from a reduced ability to handle expensive treatments, it is timely to conduct a study using validated questionnaires and an already assembled cohort. Financial burden/stress and quality of life can be compared in men cured of prostate cancer who may suffer from treatment side effects (and their families) and in families of men who have died of prostate cancer versus families with prostate cancer patients who have suffered death from other causes.

Ultimate Applicability of the Research:

Types of Patients Helped: Most men diagnosed with prostate cancer suffer side effects or expense from its treatment. This is especially true if prostate cancer progresses to metastases, in which case almost all men will die from their disease. Previously, these men underwent the inexpensive treatment of surgical castration. Now, injections have replaced castration and are expensive, and when they fail there are seven new FDA-approved treatments that are extremely expensive. Hence, many prostate cancer patients and their families will incur significant financial burden and stress as a result of a diagnosis of prostate cancer.

Potential Clinical Applications and Benefits: As many as 20% of family members stopped working, 30% of families lost all savings, and 30% of caregivers spend more than 10% of all household income on the care of patients with serious disease. The cost to the family unit from men diagnosed with prostate cancer has been studied rarely and most of those studies are a decade old and hence cannot assess the effect of the seven new FDA-approved treatments. Patients with advanced prostate cancer and their families need their financial situations assessed carefully to see whether targeted interventions must be made to prevent suffering beyond that directly due to their disease.

Projected Time to Patient-Related Outcome: The fluidity of our healthcare system and the acuteness of the challenge posed by the seven new FDA-approved treatments for advanced prostate cancer and the extreme costs of the targeted therapies now becoming available make it timely to acquire the data necessary to prevent financial ruin by a diagnosis of prostate cancer. The urgency of the situation suggests that the time necessary to impact favorably the patient-related outcome of financial burden and stress should be short.

Likely Contributions of This Study to Advancing the Field of Prostate Cancer Health Disparity Research: All men with side effects from treatment of localized prostate cancer or who utilize the seven new, expensive FDA-approved medications for treatment of advanced prostate cancer incur financial burden and distress. Those men who have less socioeconomic reserve and are less sophisticated in their ability to interact with the American healthcare system will suffer disproportionately. These men are more likely to be African than Caucasian American. Hence, identifying the extent of financial burden and stress and developing targeted interventions to mitigate financial burdens and stress will impact all men who are socioeconomically disadvantaged and hence contribute to reducing racial disparity in financial burden and stress and thereby improving survivorship.