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Survivors of genitourinary cancer are not getting the financial support they need to receive optimal treatment, including mental health services, according to a survey report in .

The findings have "substantial" implications for policy and practice, said Laura Bukavina, MD, MPH, MSc, of Case Western Reserve School of Medicine in Cleveland, and co-authors. Comprehensive insurance reforms along with other policy interventions are crucially needed to relieve the financial distress experienced by survivors of bladder, prostate, and kidney cancer, the researchers said.

Treatment for urologic cancer needs to be more affordable and more accessible, the team continued. "Advocacy for comprehensive insurance coverage that includes mental health is not just about broadening the scope of services but also about recognizing and responding to the interconnectedness of physical and mental health for the well-being of our cancer survivors."

As is well known financial distress in cancer patients and survivors has been shown to trigger reduced adherence to medication and treatment, diminished quality of life, and increased mortality, the authors noted. A 2020 demonstrated that even a 4-week delay in treatment was associated with increased mortality in seven cancer types. has also been reported in prostate, bladder, and kidney cancer survivors with limited access to mental health services (hazard ratios of 3.83, 3.33, and 2.46, respectively).

Following the team's retrospective analysis of national data (2008-2018) from more than 100,000 in-person interviews, Bukavina and co-authors found that younger genitourinary cancer survivors were hit hardest by the financial distress associated with treatment. Some 25% of those surveyed with bladder cancer and 4.7% of those with kidney cancer said they couldn't afford care compared with 2.7% of individuals without cancer.

Younger genitourinary cancer survivors were also more likely to avoid much-needed dental care because of the costs, including 27% of survivors with bladder cancer and 15% with kidney cancer.

In addition, the survey showed higher rates of care avoidance among genitourinary cancer survivors compared with peers without cancer. However, it was the older survivors of bladder cancer -- those age 65 and older who reported having less financial distress than younger survivors -- who were significantly more likely to postpone or neglect medical care compared with individuals without cancer.

This highlights "a broader spectrum of ," wrote Bukavina and co-authors. "This issue is particularly pertinent for patients with noninvasive bladder cancer, who require frequent and long-term monitoring and face additional burdens such as travel and work-related absences, thereby exacerbating their financial toxicity."

"A has been made to increase awareness of mental health issues, improve comfort levels in discussing mental health issues with patients, and to educate urologists to make appropriate referrals to psychiatric and/or psycho-oncology providers," the researchers said.

In the following interview, Bukavina, who is translational science lead in GU Oncology at Cleveland Clinic Lerner College of Medicine, discussed the critical role that physicians can play to help alleviate patients' financial distress.

Were you surprised by the lack of affordability of mental health services?

Bukavina: Yes. Even though this is a well-known issue within the cancer community, witnessing the financial barriers faced by cancer survivors was eye-opening.

Can physicians strengthen advocacy for more comprehensive insurance coverage for survivors of bladder, prostate, and kidney cancers?

Bukavina: Absolutely. Collectively, physicians can push for the inclusion of comprehensive services, such as mental healthcare and survivorship support, in clinical guideline-based recommendations for surveillance and treatment of GU cancers.

This will drive better insurance coverage on a national level, and in turn, improve access to care. As we know from the literature, better access ultimately leads to better patient outcomes.

Do individual physicians have a role to play?

Bukavina: Yes. It is every physician's responsibility to understand the hospital-supported programs that involve financial counselors and care coordinators to address patients' mental health and financial burdens.

Doctors should think of this as building their own multidisciplinary team for survivorship. Where barriers exist, physicians can work to designate services or establish pathways that integrate mental health support into the standard recovery process for cancer survivors. Mental health services should be routinely included as essential components of cancer recovery.

Can the lessons learned about the use of nurse navigators, clinical pharmacists, and financial planners to relieve financial distress in patients with hematological malignancy be applied to survivors of GU cancer?

Bukavina: Absolutely. While each malignancy presents its own unique challenges, there are striking similarities, particularly regarding mental health. Therefore, we can build on the already established protocols and pathways used in hematologic malignancies to support our GU cancer survivors.

What is the main take-home message for physicians?

Bukavina: To address financial distress and toxicity, the first step is to simply ask your patients if they're having difficulty managing the costs associated with their cancer care. I strongly encourage doctors to initiate this conversation.

What's next for your research?

Bukavina: We are focusing on sex-specific mental health challenges within genitourinary cancers, as men and women face different survivorship concerns.

Read the study here.