Association of Financial Burden with Symptom Burden and Health Related Quality of Life in Prostate Cancer Patients Receiving Radiation Treatment

Abstract

There is paucity of data on the association between financial burden (FB) and other patient reported outcomes (PROs) in Prostate cancer (PC) patients. In this study, we aim to evaluate the relationship of FB with symptom burden (SB) and health related quality of life (HRQOL) in PC patients receiving definitive radiation treatment. One hundred and forty-six (146) PC patients treated with definitive radiation from 2017 to 2018 completed a set of PRO questionnaires including Comprehensive Score for financial Toxicity (COST), a single-item measure (0 to 5) of FB (FQ), SF-12, AUA Symptom Index (AUASI) score, and the Expanded Prostate Cancer Index Composite (EPIC) in our prospective IRB approved registry. FB was measured using the COST and FQ. Higher COST and lower FQ are associated with better financial well-being. HRQOL was measured using the SF-12 for physical/mental function, and the EPIC. SB was measured using the AUASI for lower urinary tract symptoms. We utilized repeated measures mixed models to determine the effect of FB on patient-reported SB and HRQOL. Median age was 69 years (range 44 – 83). Patients present with a median T stage of T2a (range: 1 – 3b), 83.6% had N0 disease. Median baseline COST and FQ were 36 (range 9 - 44), and 2 (range 1 - 5), respectively. Patients with high risk of FB had lower COST and higher FB 19.9% (n = 29), intermediate risk had one risk factor 59.6% (n = 87), and low risk had no risk factors 20.6% (n = 30). 93.15% of patients had health insurance at the time of the survey (70.5% public, 22.6% private). On univariate analysis, patients with higher COST (less FB) had less SB and better HRQOL by SF-12, EPIC domains: overall, urinary function, urinary bother, bowel function, sexual function, and hormonal function (p<.001). Similarly, patients with lower baseline FQ (less FB) had less SB and better HRQOL by SF-12 (p<0.001), AUASI (p = .03), urinary bother (p = .04), bowel function (p = .001), sexual function (p = .0007), and hormonal function (p<.0001). However, lower baseline FQ (less FB) was not significant on overall EPIC, urinary symptoms, and urinary function. In multivariate models adjusted for age, T, N, and M stage; COST and FQ remained independent and statistically significant predictors for every HRQOL and SB domains measured by SF-12, AUA, and EPIC (p<0.02). In PC patients receiving radiation therapy, financial burden is significantly associated with symptom burden and HRQOL in multiple PRO domains. While the multiple item COST demonstrated higher association and more predictive power, the single-item overall financial burden question (FQ) also provided significant insight into patient-reported outcomes. Health care initiatives should address and study financial burden.