Duke Cancer Institute; Sanford School of Public Policy, Duke University, Durham, NC.
J Natl Cancer Inst. 2015 Dec 11;108(5). doi: 10.1093/jnci/djv370. Print 2016 May.
Evidence suggests that a considerably large proportion of cancer patients are affected by treatment-related financial harm. As medical debt grows for some with cancer, the downstream effects can be catastrophic, with a recent study suggesting a link between extreme financial distress and worse mortality. At least three factors might explain the relationship between extreme financial distress and greater risk of mortality: 1) overall poorer well-being, 2) impaired health-related quality of life, and 3) sub-par quality of care. While research has described the financial harm associated with cancer treatment, little has been done to effectively intervene on the problem. Long-term solutions must focus on policy changes to reduce unsustainable drug prices and promote innovative insurance models. In the mean time, patients continue to struggle with high out-of-pocket costs. For more immediate solutions, we should look to the oncologist and patient. Oncologists should focus on the value of care delivered, encourage patient engagement on the topic of costs, and be better educated on financial resources available to patients. For their part, patients need improved cost-related health literacy so they are aware of potential costs and resources, and research should focus on how patients define high-value care. With a growing list of financial side effects induced by cancer treatment, the time has come to intervene on the "financial toxicity" of cancer care.
有证据表明,相当大比例的癌症患者受到与治疗相关的经济伤害。随着一些癌症患者的医疗债务不断增加,其后续影响可能是灾难性的,最近的一项研究表明,极度财务困境与更高的死亡率之间存在关联。至少有三个因素可以解释极度财务困境与更高的死亡率之间的关系:1)整体健康状况较差,2)健康相关生活质量受损,3)护理质量欠佳。尽管研究已经描述了与癌症治疗相关的财务伤害,但在有效干预这一问题方面做得还很少。长期解决方案必须侧重于政策改革,以降低不可持续的药品价格并促进创新保险模式。与此同时,患者仍在为高昂的自付费用而苦苦挣扎。为了更直接的解决方案,我们应该关注肿瘤学家和患者。肿瘤学家应该关注所提供的护理的价值,鼓励患者参与成本问题,并更好地了解患者可获得的财务资源。就患者而言,他们需要提高与成本相关的健康素养,以便了解潜在的成本和资源,研究应集中于患者如何定义高价值护理。随着癌症治疗带来的一系列日益增多的财务副作用,现在是时候干预癌症护理的“财务毒性”了。