Health-related quality of life and financial toxicity among patients with gynecological cancers in southern Nigeria: A multicenter cross-sectional study.

Abstract

11102 Background: Gynecological cancer-related morbidity and the financial burden of care impact the quality of life of patients. However, the health-related quality of life (HRQoL) and experience of financial toxicity (FT) of affected women in sub-Saharan Africa have not been sufficiently explored. This study assessed predictors of HRQoL and FT, and the effect of FT on HRQoL among women with gynecological cancers in Nigeria. Methods: This hospital-based cross-sectional study investigated consenting women with gynecological cancers receiving care at various stages at five academic hospital centers in southern Nigeria, between June 2022 and September 2024. The main outcomes were HRQoL and FT evaluated using the FACT-G and FACIT-COST tools, respectively. Patients' sociodemographic and clinical characteristics were additionally retrieved using a structured questionnaire. Multivariable linear regression models estimated the associations of patient and disease characteristics with HRQoL and FT, and the effect of FT on HRQoL, adjusting for potential confounders. Ethical approval was obtained from all centers. Results: Overall, 574 women were recruited with a mean FACT-G score of 58 (SD ± 15) and a median FACIT-COST score of 16. Of these, 92.8% experienced FT, with 42.6% having moderate-to-severe FT. After multivariable adjustments, HRQoL was significantly poorer among unemployed women (β = -2.4; 95%CI: -4.8, -0.02; p = .048), women with ovarian (β = -3.4; 95%CI: -6.4, -0.4; p = .028) and uterine cancers (β = -3.8; 95%CI: -7.0, -0.6; p = .021) and choriocarcinoma (β = -7.8; 95%CI: -15, -0.2; p = .045), and women with stages II (β = -4.6; 95%CI: -7.7, -1.6; p = .003), III (β = -5.5, 95%CI: -8.9, -2.2; p = .001), and IV disease (β = -4.6; 95%CI: -8.7, -0.4; p = .031). Conversely, patients in remission had significantly better HRQoL (β = 9.3; 95%CI: 5.0, 14; p < .001). FT was worse with stages III (β = -2.2; 95%CI: -4.0, -0.4; p = .016) and IV disease (β = -5.4; 95%CI: -7.6, -3.2; p < .001), and in women on active treatment (β = -2.9; 95%CI: -4.4, -1.3; p < .001). However, older women (β per 10-year increase in age = 0.6; 95%CI: 0.1, 1.1; p = .029), those with health insurance (β = 3.4; 95%CI: 1.4, 5.5; p < .001), higher income (β per 1000 Naira = 0.02; 95%CI: 0.01, 0.03; p = .004), ovarian cancer (β = 1.9; 95%CI: 0.3, 3.6; p = .021) and choriocarcinoma (β = 6.7; 95%CI: 2.6, 11; p = .001) had lower FT. FT scores varied linearly with HRQoL after adjustments, with better HRQoL per unit lower FT (β = 0.46; 95% CI: 0.3, 0.6; p < .001). This effect was more pronounced in women with a first tumor (β = 0.53; 95% CI: 0.4, 0.7; p < .001), those in pre-treatment (β = 0.69; 95% CI: 0.4, 1.02; p < .001) and those in remission (β = 0.69; 95% CI: 0.04, 1.3; p = .037). Conclusions: Our findings identify possible predictors of HRQoL and FT, and suggest potential benefits of reducing FT on the HRQoL of women with gynecological cancers in Nigeria.