Outcomes Research Branch, Applied Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland.
Cancer. 2013 Oct 15;119(20):3710-7. doi: 10.1002/cncr.28262. Epub 2013 Jul 31.
Financial problems caused by cancer and its treatment can substantially affect survivors and their families and create barriers to seeking health care.
The authors identified cancer survivors diagnosed as adults (n=1556) from the nationally representative 2010 National Health Interview Survey. Using multivariable logistic regression analyses, the authors report sociodemographic, clinical, and treatment-related factors associated with perceived cancer-related financial problems and the association between financial problems and forgoing or delaying health care because of cost. Adjusted percentages using the predictive marginals method are presented.
Cancer-related financial problems were reported by 31.8% (95% confidence interval, 29.3%-34.5%) of survivors. Factors found to be significantly associated with cancer-related financial problems in survivors included younger age at diagnosis, minority race/ethnicity, history of chemotherapy or radiation treatment, recurrence or multiple cancers, and shorter time from diagnosis. After adjustment for covariates, respondents who reported financial problems were more likely to report delaying (18.3% vs 7.4%) or forgoing overall medical care (13.8% vs 5.0%), prescription medications (14.2% vs 7.6%), dental care (19.8% vs 8.3%), eyeglasses (13.9% vs 5.8%), and mental health care (3.9% vs 1.6%) than their counterparts without financial problems (all P<.05).
Cancer-related financial problems are not only disproportionately represented in survivors who are younger, members of a minority group, and have a higher treatment burden, but may also contribute to survivors forgoing or delaying medical care after cancer.
癌症及其治疗所带来的经济问题会对患者及其家庭造成严重影响,从而导致他们在寻求医疗服务方面面临障碍。
作者从具有全国代表性的 2010 年全国健康访谈调查中确定了 1556 名成年癌症患者。使用多变量逻辑回归分析,作者报告了与感知癌症相关经济问题相关的社会人口统计学、临床和治疗相关因素,以及经济问题与因费用而放弃或延迟医疗保健之间的关系。使用预测边缘方法呈现调整后的百分比。
31.8%(95%置信区间,29.3%-34.5%)的患者报告了与癌症相关的经济问题。在患者中,与癌症相关的经济问题显著相关的因素包括诊断时年龄较小、少数族裔、化疗或放疗史、复发或多种癌症以及从诊断到现在的时间较短。在调整协变量后,报告存在经济问题的受访者更有可能延迟(18.3%比 7.4%)或放弃整体医疗保健(13.8%比 5.0%)、处方药物(14.2%比 7.6%)、牙科保健(19.8%比 8.3%)、眼镜(13.9%比 5.8%)和心理健康保健(3.9%比 1.6%),而不是没有经济问题的患者(所有 P<.05)。
与癌症相关的经济问题不仅在年龄较小、少数族裔和治疗负担较重的患者中不成比例地存在,而且可能导致癌症患者在癌症后放弃或延迟医疗保健。