Presentations

Abstract

Introduction: Health Related Quality of Life (HRQOL) affects prostate cancer care and survivorship. Prior work has shown that patients with greater social needs experience worse QoL throughout the cancer continuum. This study seeks to examine whether community level vulnerability is associated with lower baseline HRQOL in patients with prostate cancer (PCa).

Methods: Deidentified data for participants in the CaPSURE registry were geocoded and combined with publicly available Social Vulnerability Index (SVI) data. Patients were deemed 'high' SVI if their community was ≥90thpercentile nationally for overall SVI rankings and the four SVI domains: socioeconomic status (SES), racial and ethnic minority status (REMS), housing type and transportation (HTT), and household characteristics (HC). Patients reported HRQOL (0-100 (best) scores) prior to PCa treatment using SF-36 general health (GH), physical function (PF) and mental health (MH) scales and the UCLA Prostate Cancer Index urinary function and bother (UF, UB), sexual function and bother (SF, SB), and bowel function and bother (BF, BB). Mean HRQOL scores were compared by SVI group with t-test.

Results: The cohort included 9,027 individuals (10% non-Hispanic Black, 86.3% non-Hispanic White, 3.7% Asian/Latino/Other) with mean age of PCa diagnosis being 65.3 (SD 8.8). Nearly half of the cohort (47.5%) resided in communities with high SVI. By SVI domain, 15.9% had high community SVI by SES; 5.8% had high community SVI by REMS; 23.2% high community SVI by HTT; and 30.8% high community SVI by HC. We found that patients from high SVI communities reported worse baseline scores for GH (73.3 vs 71.2, p<0.001), PF (87.4 vs 83.5, p<0.001), UB (86.3 vs 84.3, p<0.005), SF (55.4 vs 51.1, p<0.001), and SB (63.9 vs 60.0, p<0.001). MH, UF, BF, and BB did not differ significantly for patients with high community SVI vs those with low community SVI.

Conclusion: Our study found that at baseline HRQoL scores differ significantly by the extent of community vulnerability for men with PCa. Men living in areas of high community vulnerability experienced worse GH, PF, UB, SF, and SB compared to those in areas of low vulnerability. These findings point to a greater baseline health burden for patients living in vulnerable communities, which may be further exacerbated by the potential morbidity of PCa treatment. This study illustrates significant relationships between SVI and baseline HRQOL for men with PCa undergoing treatment in community urology settings, with implications for post-treatment QoL outcomes. When caring for PCa patients, especially those residing in vulnerable areas, HRQoL factors must be considered throughout their treatment course. Further assessment of long-term QoL changes over time after treatment, in the context of vulnerability, will identify those at greater risk and provide actionable targets for intervention.