Medical Student Donald and Barbara Zucker School of Medicine at Hofstra/Northwell
Introduction: Financial toxicity (FT) in cancer survivors is associated with low quality of life and poor cancer outcomes. Although bladder cancer is a common malignancy that usually involves costly treatment over a long period of time, there is limited data characterizing the nature of FT in these patients. Our objective was to investigate the relationship between FT and quality of life and assess if FT grew with time since cancer diagnosis. Methods: Bladder cancer patients were prospectively recruited from an NCI-designated cancer center. Validated measures of the Comprehensive Score for Financial Toxicity (COST) and Bladder Cancer-specific Functional Assessment of Cancer Therapy (FACT-Bl) were used to assess FT and health-related quality of life (HRQOL), respectively. Additional demographic and clinical data were collected from medical records. Bivariate and multivariable logistic regression analyses were used to examine associations between questionnaires and sub-components. Logistic regression analysis was used to assess the relationship between FT and time since cancer diagnosis. Results: 100 patients completed baseline questionnaires. We defined a prior high financial hardship as >75th percentile of COST and used the study mean for FACT-Bl. On bivariate analyses, COST scores were negatively correlated with the FACT-Bl total score (r=-.345, p=.0005), physical domain (r=-.287, p=.004), social domain (r=-.341, p=.0005), and functional domain (r=-.217, p=.032). Logistic regression analysis showed low physical well-being (physical domain of FACT-Bl) was associated with high FT-related psychological burden (psychological domain of COST) after adjusting for age, sex, race, education, and working status (OR: 3.556 CI: 1.128, 11.218; p<.05). Finally, patients over 1 year from diagnosis were more likely to endorse not feeling in control of their finances (single COST item) when controlling for race, sex, language, education, and treatment facility (OR 2.936, CI 1.010, 8.538; p<.05) on logistic regression analysis. Conclusions: High FT is associated with low HRQOL. Specifically, patients experiencing high psychological aspects of FT are more likely to experience low levels of physical wellbeing. Furthermore, as time since cancer diagnosis grows, patients are less likely to report feeling in control of their financial situation, reinforcing the uniquely high burden of survivorship in bladder cancer. SOURCE OF Funding: Grants from the Bladder Cancer Advocacy Network and the Wright Foundation/Southern California Clinical and Translational Science Institute.
