Quality of life and cervical cancer chemoradiation treatment compliance at a safety-net hospital (500)

Abstract

<b>Objectives:</b> The purpose of this study was to utilize a validated cervical cancer quality of life survey to investigate the relationship between patient-perceived quality of life (QOL) and radiation therapy compliance in a safety-net hospital since noncompliance with scheduled radiation significantly increases local recurrence risk for each day treatment is extended. <b>Methods:</b> This prospective, single-institution study included 94 patients undergoing definitive concurrent chemoradiation for cervical cancer from November 2017 to July 2021. The Functional Assessment of Cancer Therapy - Cervical Cancer Version 4 (FACTCx) was used to assess QOL based on four subscales applicable to a broad population (Physical, Functional, Social/Familial, and Emotional) and one cervical cancer-specific subscale. Higher scores were associated with a higher quality of life. The survey was provided at the initial radiation consult, weekly during external beam radiation therapy, and follow-up appointments. FACT-Cx scores were evaluated over time and compared between compliant and noncompliant patients at baseline and each week of treatment using independent t-test analysis. Patient compliance and other clinical factors were abstracted from chart review. Noncompliance was defined as patient initiating (i.e., not due to weather closure or machine malfunction) and missing at least two radiation treatments. Time to noncompliance was defined as the radiation fraction at which the patient became noncompliant. <b>Results:</b> Twenty-seven of the 94 enrolled patients (28.7%) were non- compliant. Physical QOL of noncompliant patients was significantly impaired compared to compliant patients at baseline (Physical QOL, p=0.007) and at each of the first four weeks of radiation therapy. The functional QOL and cervical QOL scores of noncompliant patients were lower at baseline than compliant patients' scores, and the differences were statistically significant at each of the first four and five weeks, respectively. Differences between social QOL and emotional QOL scores at baseline and at each week of radiation were not statistically significant. The total QOL score of noncompliant patients was significantly lower compared to that of the compliant patients at baseline (Total QOL, p=0.010) and at each of the first five weeks. The median fraction when patients become noncompliant was 10 (IQR: 6-18). Change in QOL from baseline during treatment was not associated with patient-initiated noncompliance. <b>Conclusions:</b> This longitudinal prospective analysis suggests that multiple indicators of QOL, including physical, functional, and cervical well-being, are associated with noncompliance to therapy. The median fraction at which patients become noncompliant also suggests 2-3 weeks of treatment as the highest-risk time frame for patient-initiated noncompliance. Therefore, these results may be used to identify patients at risk of missing treatments and allow their physicians to intervene in a timely manner to improve treatment course and outcome.