目的:财务毒性用于描述癌症患者所经历的财务困难。财务毒性可能会对患者造成负面影响,而在中国语境中鲜为人知。本研究旨在探讨金融毒性的水平,应对策略,中国恶性血液病患者的生活质量。
方法:我们进行了前瞻性,2021年11月至2022年8月在中山大学肿瘤中心接受治疗的274例中国恶性血液病患者的观察性研究.从电子临床记录中提取临床数据。金融毒性数据,应对策略,和生活质量的收集使用PRO措施。采用卡方检验或独立t检验和多因素logistic回归分析财务毒性与生活质量的相关因素。分别。使用卡方检验了金融毒性对应对策略的影响。
结果:参与者的平均年龄为50.2(±14.6)岁。男性参与者占57.3%。大约一半的参与者报告了高财务毒性。自报告诊断以来,医疗总支出的平均中位数为200,000日元。报销后,与癌症治疗有关的每月平均自付医疗支出中位数为20,000日元(范围为632-172,500日元)。降低日常生活开支(64.9%),借钱(55.7%),选择更便宜的方案(19.6%)是应对经济负担的常用策略。财务毒性与生活质量呈负相关(β=0.071,P=0.001)。
结论:金融毒性在血液系统恶性肿瘤患者中并不少见。减少日常生活开支,放弃治疗,借钱是参与者支付癌症费用的常用策略。此外,经济毒性水平较高的参与者往往生活质量较差.因此,医疗保健提供者的行动,决策者,和其他利益相关者应采取帮助癌症患者减轻其财务毒性。
OBJECTIVE: Financial toxicity is used to describe the financial hardship experienced by cancer patients. Financial toxicity may cause negative consequences to patients, whereas little is known in Chinese context. This study aimed to explore the level of financial toxicity, coping strategies, and quality of life among Chinese patients with hematologic malignancies.
METHODS: We conducted a prospective, observational study among 274 Chinese patients with hematologic malignancies from November 2021 to August 2022 in Sun Yat-sen University Cancer Center. Clinical data were extracted from electronic clinical records. Data on financial toxicity, coping strategies, and quality of life were collected using PRO measures. Chi-square or independent t test and multivariate logistic regression were performed to explore the associated factors of financial toxicity and quality of life, respectively. Effects of financial toxicity on coping strategies were examined using Chi-square.
RESULTS: The mean age of the participants was 50.2 (± 14.6) years. Male participants accounted for 57.3%. About half of the participants reported high financial toxicity. An average median of ¥200,000 on total medical expenditures since the diagnosis was reported. The average median monthly out-of-pocket health expenditure relating to cancer treatment was ¥20,000 (range ¥632-¥172,500) after reimbursement. Reduce daily living expenses (64.9%), borrowing money (55.7%), and choosing cheaper regimens (19.6%) were the commonly used strategies to cope with financial burden. Financial toxicity was negatively associated with quality of life (β = 0.071, P = 0.001).
CONCLUSIONS: Financial toxicity was not uncommon in patients with hematological malignancies. Reducing daily living expenses, abandoning treatment sessions, and borrowing money were the strategies commonly adopted by participants to defray cancer costs. Additionally, participants with high level of financial toxicity tended to have worse quality of life. Therefore, actions from healthcare providers, policy-makers, and other stakeholders should be taken to help cancer patients mitigate their financial toxicity.