Impact of whole brain radiotherapy after treatment of melanoma brain metastases on an individual’s employment and household income

Purpose: A cancer diagnosis can result in a considerable financial burden to individuals and their households. This study aimed to investigate this problem in patients treated for melanoma brain metastases. Methods: An economic evaluation was conducted as a sub-study of a randomised controlled trial of whole brain radiotherapy (WBRT) versus observation following surgery and/or stereotactic radiosurgery (SRS) for 1-3 melanoma brain metastases. Employment status and pre-tax household income were measured at baseline and every 2 months for 12 months. Outcomes included changes in employment status or household income category at 12 months. Results: Of 125 patients, 64 were included in the analysis, 31 randomised to WBRT and 33 to observation, 61 patients were excluded because they were not in the workforce at baseline (42) or were unsure about their income (19). Mean age was 61 years (range 27-88), 37 (58%) completed employment questionnaires and 61 (96%) completed income questionnaires at baseline. Prior to treatment, 39% worked full-time, 8% part-time and 53% were unemployed. At 12 months, 23%, 12% and 65% individuals were employed full-time, part-time and unemployed, respectively. Job status change and household income at 12 months were not significantly different between the two treatment groups (p=0.18 and 0.87, respectively). Conclusions: A substantial proportion of patients experienced job loss after treatment of melanoma brain metastases, however this was similar for those undergoing WBRT or observation alone. Strategies to reduce the impact for both groups (e.g., financial counselling, employment rehabilitation) could be implemented by clinicians and allied health workers.