University of Washington, Fred Hutchinson Cancer Research Center, Seattle Cancer Care Alliance, Seattle, WA 98109, USA.
J Clin Oncol. 2012 May 10;30(14):1608-14. doi: 10.1200/JCO.2011.37.9511. Epub 2012 Mar 12.
Characteristics that predispose patients to financial hardship during cancer treatment are poorly understood. We therefore conducted a population-based exploratory analysis of potential factors associated with financial hardship and treatment nonadherence during and following adjuvant chemotherapy for colon cancer.
Patients diagnosed with stage III colon cancer between 2008 and 2010 were identified from a population-based cancer registry representing 13 counties in Washington state. Patients were asked to complete a comprehensive survey on treatment-related costs. Patients were considered to have experienced financial hardship if they accrued debt, sold or refinanced their home, borrowed money from friends or family, or experienced a 20% or greater decline in their annual income as a result of treatment-related expenses. Logistic regression analysis was used to investigate factors associated with financial hardship and treatment nonadherence.
A total of 284 responses were obtained from 555 eligible patients (response rate, 51.2%). Nearly all patients in the final sample were insured during treatment. In this sample, 38% of patients reported one or more financial hardships as a result of treatment. The factors most closely associated with treatment-related financial hardship were younger age and lower annual household income. Younger age, lower income, and unemployment or disability (which occurred in most instances following diagnosis) were most closely associated with treatment nonadherence.
A significant proportion of patients undergoing adjuvant chemotherapy for stage III colon cancer may experience financial hardship, despite having health insurance coverage. Interventions to help at-risk patients early on during therapy may prevent long-term financial adverse effects.
癌症治疗过程中导致患者经济困难的特征尚未得到充分理解。因此，我们进行了一项基于人群的探索性分析，以研究与接受结直肠癌辅助化疗期间和之后的经济困难和治疗不依从相关的潜在因素。
从代表华盛顿州 13 个县的基于人群的癌症登记处中确定了 2008 年至 2010 年间被诊断患有 III 期结肠癌的患者。患者被要求完成一项关于治疗相关费用的综合调查。如果患者因治疗相关费用而负债、出售或再融资房屋、向朋友或家人借钱、或年收入下降 20%或以上，则认为其经历了经济困难。使用逻辑回归分析来调查与经济困难和治疗不依从相关的因素。
从 555 名合格患者中获得了 284 份回复（回复率为 51.2%）。最终样本中的所有患者在治疗期间均有保险。在该样本中，38%的患者因治疗而报告了一种或多种经济困难。与治疗相关的经济困难最密切相关的因素是年龄较小和年收入较低。年龄较小、收入较低、失业或残疾（大多数情况下发生在诊断后）与治疗不依从最密切相关。
尽管有医疗保险覆盖，但接受 III 期结直肠癌辅助化疗的患者中仍有相当一部分可能会经历经济困难。在治疗早期为高风险患者提供帮助的干预措施可能会预防长期的财务不利影响。
