Özman Oktay, Tillier Corinne N, van Muilekom Erik, van de Poll-Franse Lonneke V, van der Poel Henk G
Department of Urology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
J Urol. 2022 Nov;208(5):978-986. doi: 10.1097/JU.0000000000002897. Epub 2022 Nov 1.
The aim of the study was to evaluate frequency of financial toxicity among patients who underwent robot-assisted radical prostatectomy for prostate cancer.
Data of 1,479 robot-assisted radical prostatectomy patients between 2006-2021 reporting no financial toxicity in preoperative assessments were included retrospectively. Financial toxicity was measured with financial impact of European Organisation for Research and Treatment of Cancer-quality of life questionnaire-C30. Financial impact scores were collected preoperatively, 6, 12, 18, and 24 months after robot-assisted radical prostatectomy.
The frequency of financial toxicity was 8.3% (122/1379; 95% CI 7.0-9.8) at any point in time throughout 2 years of follow-up. Patients reporting financial toxicity (63 [58-68]) were significantly younger than patients who had no financial toxicity (65 [61-69]; .001). There was no statistically significant difference between financial toxicity+ and financial toxicity- groups in terms of salvage radiotherapy ( .8) and positive surgical margin ( .2) rates. In functional assessments, clinically significant International Prostate Symptom Score and International Consultation on Incontinence Questionnaire-Short Form score increase of financial toxicity+ patients (34% and 62%) were more frequent than financial toxicity- patients (23% and 47%; .004 and .002, respectively). In multivariable analysis, age at robot-assisted radical prostatectomy, International Prostate Symptom Score, International Consultation on Incontinence Questionnaire-Short Form, and quality of life scores were associated with financial toxicity ( < .001, OR 0.95 [95% CI 0.92-0.98]; .015, OR 2.4 [95% CI 1.2-4.7]; .032, OR 1.5 [95% CI 1.2-2.5]; .01, OR 0.09 [95% CI 0.01-0.57], respectively). Patients who underwent robot-assisted radical prostatectomy before retirement (≤65 years) had a 1.6-fold increased financial toxicity risk ( .003, 95% CI 1.1-2.3).
Financial toxicity after robot-assisted radical prostatectomy is low in mid-term follow-up. Patients who report urological symptoms after robot-assisted radical prostatectomy should also be evaluated for financial toxicity. Required measures against financial toxicity should be taken especially in the follow-up of younger cancer survivors.
本研究旨在评估接受机器人辅助根治性前列腺切除术治疗前列腺癌患者的经济毒性发生率。
回顾性纳入2006年至2021年间1479例行机器人辅助根治性前列腺切除术且术前评估无经济毒性的患者数据。采用欧洲癌症研究与治疗组织生活质量问卷-C30的经济影响量表来衡量经济毒性。在机器人辅助根治性前列腺切除术前、术后6个月、12个月、18个月和24个月收集经济影响得分。
在2年的随访期间，任何时间点的经济毒性发生率为8.3%（122/1379；95%可信区间7.0-9.8）。报告有经济毒性的患者（63[58-68]）明显比无经济毒性的患者年轻（65[61-69]；P<0.001）。在挽救性放疗（P=0.8）和手术切缘阳性率（P=0.2）方面，经济毒性阳性组和阴性组之间无统计学显著差异。在功能评估中，经济毒性阳性组患者临床显著的国际前列腺症状评分和国际尿失禁咨询问卷-简表评分增加（分别为34%和62%）比经济毒性阴性组患者（分别为23%和47%）更频繁（P分别为0.004和P<0.002）。在多变量分析中，机器人辅助根治性前列腺切除术时的年龄、国际前列腺症状评分、国际尿失禁咨询问卷-简表评分和生活质量评分与经济毒性相关（P<0.001，比值比0.95[95%可信区间0.92-0.98]；P=0.015，比值比2.4[95%可信区间1.2-4.7]；P=0.032，比值比1.5[95%可信区间1.2-2.5]；P=0.01，比值比0.09[95%可信区间0.01-0.57]）。在退休前（≤65岁）接受机器人辅助根治性前列腺切除术的患者经济毒性风险增加1.6倍（P=0.003，95%可信区间1.1-2.3）。
机器人辅助根治性前列腺切除术后中期随访中经济毒性较低。机器人辅助根治性前列腺切除术后报告有泌尿系统症状的患者也应评估其经济毒性。尤其在年轻癌症幸存者的随访中应采取针对经济毒性的必要措施。
