3259 - Financial Difficulties and Long-Term Oncological Outcomes Following Prostate Radiotherapy and Androgen Deprivation Therapy - Post-Hoc Analyses of TROG0304/ RADAR Trial

W. L. Ong¹, D. J. Joseph², J. L. Millar¹, and A. U. Kishan³; ¹Alfred Health Radiation Oncology, Monash University Central Clinical School, Melbourne, Australia, ²University of Western Australia, Perth, Australia, ³Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA

Purpose/Objective(s): Several studies have reported the impact of financial toxicities of cancer treatment. However, its impact in countries with public health systems, such as Australia, is unknown. We aimed to evaluate the association of financial toxicities on long-term cancer outcomes using data from the TROG0304/RADAR trial. Materials/

Methods: Men enrolled in TROG0304/RADAR trial were included in this post-hoc analyses. Financial difficulties were prospectively captured based on the single-item in the EORTC-QLQ-C30 questionnaire “Has your physical condition or medical treatment caused you financial difficulties”, with a 4-point Likert scale response (1=not at all, 2=a little, 3=quite a bit, 4=very much). In this study, financial burden was defined as any financial difficulty (score 2-4) at baseline, and financial toxicity was defined as any worsening in score in subsequent follow-up questionnaire. Only individuals who completed the baseline and at least 1 post-treatment questionnaire were included in the analyses. Cox regression and Fine-Gray models were used to assess whether baseline financial burden and financial toxicity were associated with biochemical recurrence (BCR), distant metastases free survival (DMFS), prostate cancer specific mortality (PCSM) and overall survival (OS), adjusting for age, PSA at diagnosis, ISUP grade group, clinical tumour (T) category, duration of ADT use, and radiation therapy dose.
Results: 1046 men were included in the study, of whom 207 (20%) reported financial difficulties at baseline – 156 (15%) a little, 41 (4%) quite a bit, 10 (1%) very much. Younger men were more likely to report baseline financial burden - median (IQR) age 66.3 years (59.4-71.9) vs 69.3 years (64.5-73.3) (P<0.001). There were 350 (33%) men who reported financial toxicities in subsequent follow-up questionnaire. Younger men were more likely to report financial toxicities – median (IQR) age 67.5 years (61.2-72.1) vs 69.8 (64.6-73.7) (P<0.001). In multivariable analyses, baseline financial burden was not associated with BCR (P=0.3), MFS (P=0.7), PCSM (P=0.2) and OS (P=0.7). Financial toxicity was associated with increased risk of BCR (sHR=1.30; 95%CI=1.05-1.60; P=0.015) and PCSM (sHR=1.44; 95%CI=1.02-2.06; P=0.038), but not DMFS (P=0.07) and OS (P=0.3).
Conclusion: Data from TROG0304/RADAR trial suggests that financial toxicity was associated with poorer cancer outcomes in men who had radiation therapy for prostate cancer within the Australian healthcare settings. Efforts to reduce healthcare cost and the financial impact of cancer treatment is necessary.