Evaluating frailty and quality of life in low-income, uninsured men with prostate cancer.

334 Background: We evaluated frailty across multiple domains and examined its association with prostate cancer (PCa)-specific health-related quality of life (HRQoL) outcomes in low-income, uninsured men enrolled in the Improving Access, Counseling and Treatment for Californians with Prostate Cancer (IMPACT) Program. Methods: 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. Results: Among 358 participants (mean age 60; 68% Hispanic), 25% were frail, 45% were pre-frail, and 30% 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<0.0001). After covariate adjustment, frailty remained independently associated with worse PCa-specific HRQoL across all PCI domains, while pre-frailty showed clinically significant worse urinary bother (estimate (SE): -12.5 (5.1), p=0.0151), sexual function (-14.8 (4.4), p=0.0009), and sexual bother (-22.2 (5.8), p<0.0001) compared with non-frailty. Conclusions: 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 stratifying risk of HRQoL reduction and guiding personalized interventions to improve genitourinary dysfunction and bother in men with PCa. Frailty group comparison of adjusted PCI estimates (N=358). (non-frail group estimate used as reference) PCI Domain Estimate (SE) Urinary Function Urinary Bother Sexual Function Sexual Bother Bowel Function Bowel Bother Frail -15.8 (4.2) -29.1 (6.1) -29.0 (5.3) -27.2 (6.8) -15.8 (3.0) -23.4 (4.8) p-value a p=0.0002 p<0.0001 p<0.0001 p<0.0001 p<0.0001 p<0.0001 Pre-frail -7.4 (3.6) -12.5 (5.1) -14.8 (4.4) -22.2 (5.8) -4.1 (2.5) -8.5 (4.1) p-value a p=0.0391 p=0.0151 p=0.0009 p=0.0001 p=0.1011 p=0.0385 a p-value < .0083 is significant after Bonferroni correction.