Introduction:

In patients with localized prostate cancer, 5-fraction, ultra-hypofractionated Stereotactic Body Radiation Therapy (SBRT) has been found to offer comparable oncologic outcomes and potential for improved treatment compliance compared to conventional, 40-plus fraction radiation therapy (RT). Recent studies of oncologic patient experiences have highlighted both the impact of therapy-associated financial toxicity (FT) on treatment adherence and on health-related quality of life (HRQOL). We used a validated instrument, the Comprehensive Score for Financial Toxicity - Functional Assessment of Chronic Illness Therapy (COST-FACIT) questionnaire, to evaluate patients receiving SBRT for localized prostate cancer.

Methods:

Patients were prospectively consented to this quality of life and financial toxicity study at an urban academic center. Cross-sectional assessment of FT after SBRT using the 12-item COST-FACIT questionnaire was performed. We calculated COST-FACIT scores (range 0-4) with lower scores indicating worse FT. We then assigned FT grades based on total COST-FACIT score, with lower FT grade indicating less FT. Patient zip codes were used to approximate distance from index medical center. Baseline patient and socioeconomic characteristics by COST-FACIT grade were evaluated using Fisher’s exact test. Univariate association with COST-FACIT score for age was performed via linear regression and Wilcoxon rank-sum or Kruskal-Wallis test for the remainder of nominal and ordinal variables. We performed multiple linear regression using standard least squares method with backward selection of variables significant on univariate analysis. All tests were two-tailed and p-values <0.05 were considered significant.

Results:

Response rate of 57.5% (332 of 575 consented patients) with 90.7%, 8.2%, and 1.1% experiencing grade 0, 1, and 2 FT, respectively, and no grade 3 FT. Statistically significant differences based on FT grade groups when comparing employment status, race, income, and health insurance status; however, no statistically significant difference when comparing age, marital status, education, hospital distance, time since SBRT, or hormonal therapy. Mean COST-FACIT score per question was 3.245 out of 4. Patients without health insurance, disabled, or income ≤$14,999 had the lowest mean COST-FACIT score (2.00, 2.05, and 2.34, respectively), corresponding to worse FT. Unemployment or disability, non-white race, low income, and concurrent hormonal therapy were associated with a statistically significant worse FT on univariate and multivariate analyses, while education level and insurance status were significant on univariate analysis only. Age, marital status, time since treatment, and hospital distance were not statistically significantly correlated with COST score.

Conclusion:

Understanding aspects of oncologic care that directly impact patient experience, treatment adherence, and HRQOL is of utmost importance. Ultra-hypofractionated SBRT is associated with low overall FT. However, statistically significant socioeconomic disparities in FT remain despite ultra-hypofractionated treatment. Patients who are unemployed or have a disability, non-white, low income, or on hormonal therapy are more likely to experience significant FT after SBRT for prostate cancer.  Prospective, longitudinal analysis of FT in this patient population is needed.

Funding: N/A