Pain Relief Without Financial Relief

OBJECTIVES: Prospective data on patient-reported financial toxicity (FT) during radiation therapy for spine metastases are limited. This secondary analysis of the SPORTSMEN trial (NCT05617716) characterized FT and quality of life, including changes 3 months after treatment. METHODS: SPORTSMEN is a phase II trial randomizing patients with symptomatic spine metastases to SBRT (24 Gy/2 fractions or 19 Gy/1 fraction) or conventional EBRT (8 Gy/1 fraction). FT was measured with the COST-FACIT (lower scores indicate greater FT) and graded 0 (none) to 3 (severe); item 12 assessed familial hardship. Quality of life was measured with the EQ-5D-5L (higher scores indicate worse function) and EQ Visual Analog Scale (VAS). Analyses used Spearman correlation and the exact Wilcoxon signed-rank test. RESULTS: Of 18 enrolled patients since 2025, 15 completed baseline COST-FACIT and 17 completed EQ-5D-5L. Eight (53%) had grade 1 to 2 FT. All patients with FT reported familial financial hardship, which correlated with FT grade (ρ=0.67, P=0.007). Pain was the most impaired domain (mean: 3.9, 71% severe or extreme). Among 7 patients with 3-month data, pain decreased from 4.3 to 2.3 (P=0.0625), EQ VAS rose from 44 to 64 (P=0.34), and FT increased from 2/7 patients to 5/7 patients. CONCLUSIONS: More than half of patients had FT before radiation therapy, closely tied to familial hardship. Although pain and self-rated health improved after treatment, FT did not. Financial screening and support for patients and families should begin at diagnosis and continue after treatment.