Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, Michigan; Department of Surgery, University of Michigan, Ann Arbor, Michigan.
Cancer. 2014 Oct 1;120(19):3074-81. doi: 10.1002/cncr.28812. Epub 2014 May 29.
Patients with colorectal cancer (CRC) may suffer significant economic hardship during treatment. Complications are common after surgery for CRC and may exacerbate the financial burden of CRC even further.
Within a population-based survey of patients with stage III CRC, the authors investigated the effects of disease and treatment on personal finances and computed a composite measure of financial burden. Correlations were examined between components of financial burden and patient-reported postoperative complications using chi-square analyses, and Mantel-Haenszel chi-square tend tests were used to evaluate correlations between composite financial burden scores and surgical complications, controlling for patient characteristics and other factors by using multivariable Poisson regression.
Among 937 respondents, 224 (24%) reported complications after surgery. Those with complications had significantly higher composite financial burden (P < .001 for trend): they were more likely to spend savings (40% vs 31%; P = .01), borrow or take loans (18% vs 11%; P = .007), fail to make credit card payments (18% vs 11%; P = .005), reduce spending for food or clothes (38% vs 27%; P = .001), and decrease recreational activities (41% vs 33%; P = .03). They took significantly longer to return to work (P = .009) and were more likely to experience significant worry about finances (61% vs 52%; P = .01).
Complications after surgery for CRC result in significant personal financial consequences as well as morbidity. Financial stress impairs quality of life and may prevent adherence to recommended treatments. Therefore, patients who suffer complications may require not just additional clinical care but also economic support and services.
结直肠癌（CRC）患者在治疗过程中可能会承受重大的经济困难。CRC 手术后并发症很常见，甚至可能进一步加重 CRC 的经济负担。
在一项针对 III 期 CRC 患者的基于人群的调查中，作者研究了疾病和治疗对个人财务的影响，并计算了财务负担的综合衡量指标。使用卡方分析检验财务负担各组成部分与患者报告的术后并发症之间的相关性，使用 Mantel-Haenszel 卡方趋势检验评估综合财务负担评分与手术并发症之间的相关性，使用多变量泊松回归控制患者特征和其他因素。
在 937 名受访者中，有 224 人（24%）报告手术后出现并发症。有并发症的患者的综合财务负担明显更高（趋势 P < .001）：他们更有可能动用储蓄（40% vs 31%；P = .01）、借款或贷款（18% vs 11%；P = .007）、无法偿还信用卡款项（18% vs 11%；P = .005）、减少食品或衣服支出（38% vs 27%；P = .001）以及减少娱乐活动（41% vs 33%；P = .03）。他们返回工作岗位的时间明显更长（P = .009），并且更有可能对财务状况感到担忧（61% vs 52%；P = .01）。
CRC 手术后的并发症不仅会导致发病率增加，还会对个人财务造成重大影响。经济压力会降低生活质量，并可能妨碍对推荐治疗的遵守。因此，遭受并发症的患者不仅需要额外的临床护理，还需要经济支持和服务。
