Association of financial toxicity with quality of life in testicular cancer survivors.

OBJECTIVES: Most testicular cancer (TC) survivors have long-term survival. However, the association between financial toxicity (FT), which is an economic side effect of cancer treatment, and the quality of life (QOL) of TC survivors is still unclear. Thus, the impact of FT on the QOL of TC survivors was examined in a multi-institutional cross-sectional study. METHODS: We recruited TC survivors from eight high-volume institutions in Japan between January 2018 and March 2019. A total of 562 participants completed the EORTC QLQ-C30, EORTC QLQ-TC26 and the questionnaires on demographics, including annual income. Financial difficulty in the EORTC QLQ-C30 and low income were used to assess financial distress (FD) and financial burden (FB), respectively. FT was defined as FD and FB. The QOL scores were compared, and a multivariate logistic regression analysis for FT was performed. RESULTS: With severe FD, TC survivors had more treatment side effects, physical limitations, and anxiety concerning employment and future. The TC survivors who reported low income were worried about their jobs and the future. The QOL of the survivors with FT exhibited high impairment, except for sexual activity. In particular, the TC survivors with FT were physically limited and anxious concerning the future. The multivariate logistic regression analysis revealed that four or more chemotherapy cycles were substantial risk factors for FT (4 cycles, odds ratio (OR) = 4.17; ≥5 cycles, OR = 6.96). CONCLUSIONS: TC survivors who received multi-cycle chemotherapy were prone to experience FT, resulting in a decline in their health-related QOL.

[Clinical pathway for retropubic radical prostatectomy].

The efficacy of an all-in-one clinical pathway for retropubic radical prostatectomy (RRP) was assessed. A total of 60 patients were enrolled, including 33 before the introduction of the pathway (mean age 67.3) and 27 after the introduction (mean age 66.4). The introduction of the pathway significantly improved recovery after the surgery, such as time of ambulant (mean postoperative day 1.5 vs 1.1), food intake (1.3 vs 1.0) and duration of intravenous fluid administration (3.1 vs 2.5). The mean postoperative hospital stay was shortened by 2.1 days (p = 0.06). Medical fees decreased by yen 94170 (p < 0.05). The variance related to the removal of a urethral catheter was observed in seven cases. The catheters were indwelled 3-7 days longer. According to the questionnaire survey, 80% of nurses had good impression on the path because the introduction of the path resulted in improving patient assessment, volume of nurse records, simplicity of the overall description and handling nurse records. The RRP clinical pathway is useful to achieve early recovery, short hospital stay and cost reduction.