Treatment Deferral and Coping Mechanisms Associated with Nephrolithiasis-Related Financial Toxicity.

Abstract

Objective: To assess how financial toxicity may impact risk of deferral of recommended therapy in nephrolithiasis patients.

Methods: We performed a nationwide cross-sectional survey of adult volunteers with kidney stone disease registered with ResearchMatch. Comprehensive Score for Financial Toxicity (COST-FACIT) score <21 was used to identify patients with nephrolithiasis-related financial toxicity. Coping mechanisms, dietary, and medical interventions for stone disease were compared between high/low financial toxicity groups. Multivariable logistic regression assessed characteristics associated with deferral of recommended medical or surgical interventions in the preceding year.

Results: Of 945 respondents with nephrolithiasis, 205 (21.6%) reported disease-related financial toxicity (COST≤20). Individuals with financial toxicity were more likely to defer recommended medical (28.3% vs. 3.8%;P<0.001) or surgical therapy (22.4% vs. 3.4%;P<0.001) for stones in the preceding year and were more likely to cite cost concerns as barriers to following nutritional recommendations (Table 1). On multivariable analysis, after controlling for income and emergency presentation for stones, higher COST-FACIT score (lower financial burden) was associated with lower odds of deferring recommend medicines or surgery for stone disease (OR 0.89, 95%CI 0.87-0.92;P<0.001).

Conclusions: In this nationwide cross-sectional study, patients with kidney stones and associated financial toxicity were more likely to defer recommended surgical and medical therapy. Cost-concerns were commonly cited reasons for not following medical, surgical, or dietary recommendations, highlighting a need to integrate this information into discussion of preventative interventions.