Quality of life and financial toxicity among survivors of small cell lung cancer.

Abstract

661 Background: Patients (pts) with SCLC experience substantial symptom burden and treatment-related morbidity, but little is known specifically of survivors of SCLC. As survivorship in lung cancer continues to improve, there is increasing recognition of the importance of the interplay between quality of life (QOL) and financial toxicity (FT). We conducted a survey-based study to evaluate the association between FT and QOL among SCLC survivors. Methods: This single-institution cross-sectional study was conducted at a NCI designated academic cancer center. We administered a survey to assess QOL and FT including EORTC QLQ-C30, EORTC QLQ-LC13, and COST questionnaires in SCLC survivors alive >1 yr from diagnosis. Associations between clinical-demographic characteristics, QOL, and FT were assessed using Wilcoxon rank-sum tests, Kruskal-Wallis tests, and Spearman correlation analyses. Covariates identified on univariable analyses were incorporated into multivariable linear regression models evaluating the association between FT and QOL, including disease stage, smoking history, insurance status, and total lines of therapy. Results: A total of 47 pts who completed the survey were included in this analysis (median age 69 years; 59.6% female; 85.1% White; 46.8% extensive-stage SCLC). Most pts were retired (78.7%) and had Medicare and/or Medicard (51.1%). Median EORTC QLQ-C30 score was 66.7 (IQR 50.0-83.3) and median COST score was 26.4 (IQR 21.5-31.9). Pts with greater FT (COST score 0-25) reported lower Global Health/QOL (p = 0.042) and physical functioning scores (p = 0.05) than those with lower FT, while fatigue and dyspnea did not differ significantly. On univariable analysis, lower QOL was associated with greater total lines of treatment (p = 0.013), insurance status (p = 0.041), prior surgery (p = 0.043), and smoking pack year history (p = 0.045). Worse FT was associated with receiving immunotherapy treatment (p = 0.024) and greater total lines of therapy (p = 0.037). On multivariable analysis adjusting for stage, smoking history, insurance status, and total lines of therapy, FT was not independently associated with global QOL (p = 0.28). However, receiving second-line therapy (p = 0.001), third-line therapy (p = 0.03) and having Medicare/Medicaid insurance (p = 0.03) was associated with lower QOL, while never-smoking history was associated with significantly improved FT (p = 0.03). Conclusions: In this survey-based study of SCLC survivors, FT was not independently associated with worse QOL after multivariable adjustment. However, later lines of therapy and Medicare/Medicaid insurance were associated with lower QOL, while never-smoking history was associated with improved FT. These findings highlight the substantial supportive care and survivorship needs of pts with SCLC, supporting further investigation into treatment-related and socioeconomic factors impacting patient-reported outcomes.