Frailty and Quality of Life in Low-Income, Uninsured Men With Prostate Cancer

To evaluate frailty across multiple domains and examine its association with prostate cancer (PCa)-specific health-related quality of life (HRQoL) in low-income, uninsured men enrolled in the Improving Access, Counseling and Treatment for Californians with Prostate Cancer (IMPACT) Program.

We retrospectively assessed frailty using a deficit accumulation frailty index, derived from the RAND SF-12v2 (12-Item Short Form Survey, version 2), California Health Interview Survey (CHIS), and Total Illness Burden Index for Prostate Cancer (TIBI-CaP). PCa-specific HRQoL was measured at IMPACT enrollment, using the UCLA Prostate Cancer Index (PCI), which covers urinary, sexual, and bowel function and bother. We analyzed associations between frailty status and PCI domains using multivariable logistic regression.

Among 342 participants (mean age: 60; 68% Hispanic), 25% were frail, 46% were pre-frail, and 29% were non-frail. Across all PCI domains, PCa-specific HRQoL was significantly worse in the pre-frail and frail groups. Sexual function demonstrated the greatest impairment (mean ± SD: non-frail 54.1 ± 33.9 vs pre-frail 38.2 ± 31.3 vs frail group 24.6 ± 28.9, P < .0001). After covariate adjustment, both pre-frailty and frailty remained independently associated with worse PCa-specific HRQoL.

Frailty is significantly associated with poorer PCa-specific HRQoL in low-income, uninsured men. These findings suggest that comprehensive frailty assessment has a role in guiding personalized interventions to improve genitourinary HRQoL outcomes in men with PCa.