Early Economic and Patient-Centered Outcomes Before Spine Metastases Radiation Therapy From an Ongoing Phase II Randomized Controlled Trial

Objectives: The incidence of metastatic spine cancer is increasing, with up to 40% of patients with metastatic disease developing spine involvement. Radiotherapy options involve conventional external beam radiation therapy (EBRT) and stereotactic body radiotherapy (SBRT). However, comparative economic impact and patient-reported financial burden remain poorly defined. This study evaluates early economic and patient-centered outcomes using prospective data from an ongoing randomized trial. Methods: This analysis is embedded within the multicenter phase II/III Spine Patient Optimal Radiosurgery Treatment for Symptomatic Metastatic Neoplasms (SPORTSMEN) trial (ClinicalTrials.gov: NCT05617716). Patients with MRI-confirmed spinal metastases and histologically confirmed primary malignancy are randomized to SBRT (24 Gy/2 fractions or 19 Gy/1 fraction) or conventional EBRT (8 Gy/1 fraction). Patient-reported financial toxicity (FT) and health-related quality of life are assessed using the COST-FACIT and EQ-5D-5L instruments. Results: Of patients with baseline data, 60% reported grade 1 to 2 financial toxicity, while 40% reported none. All patients with individual FT also endorsed familial financial strain, with a strong positive correlation between individual and familial FT ( r =0.71). Baseline EQ-5D-5L scores demonstrated moderate impairment in mobility (3.3), self-care (2.6), and usual activities (3.3), severe pain (3.9), and mild anxiety/depression (2.2). Conclusions: Preliminary findings suggest that financial toxicity is present in a majority of SPORTSMEN patients before treatment and is strongly associated with familial financial strain, highlighting the importance of early financial screening and intervention at the time of diagnosis. Baseline EQ-5D-5L data further demonstrate substantial functional impairment and pain burden, underscoring the need for early supportive and multidisciplinary interventions.