膀胱癌患者的财务毒性：延迟治疗的原因及其对生活质量的影响。
Financial Toxicity among Patients with Bladder Cancer: Reasons for Delay in Care and Effect on Quality of Life.
机构信息
School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
出版信息
J Urol. 2018 May;199(5):1166-1173. doi: 10.1016/j.juro.2017.10.049. Epub 2017 Nov 16.
PURPOSE
Costly surveillance and treatment of bladder cancer can lead to financial toxicity, a treatment related financial burden. Our objective was to define the prevalence of financial toxicity among patients with bladder cancer and identify delays in care and its effect on health related quality of life.
MATERIALS AND METHODS
We identified patients with bladder cancer in the University of North Carolina Health Registry/Cancer Survivorship Cohort. Financial toxicity was defined as agreement with having "to pay more for medical care than you can afford." Health related quality of life was measured using general and cancer specific validated questionnaires. Statistical analyses were performed using the Fisher exact test and the Student t-test.
RESULTS
A total of 138 patients with bladder cancer were evaluated. Median age was 66.9 years, 75% of the patients were male and 89% were white. Of the participants 33 (24%) endorsed financial toxicity. Participants who were younger (p = 0.02), black (p = 0.01), reported less than a college degree (p = 0.01) and had noninvasive disease (p = 0.04) were more likely to report financial toxicity. On multivariable analysis only age was a significant predictor of financial toxicity. Patients who endorsed financial toxicity were more likely to report delaying care (39% vs 23%, p = 0.07) due to the inability to take time off work or afford general expenses. On general health related quality of life questionnaires patients with financial toxicity reported worse physical and mental health (p = 0.03 and <0.01, respectively), and lower cancer specific health related quality of life (p = 0.01), physical well-being (p = 0.01) and functional well-being (p = 0.05).
CONCLUSIONS
Financial toxicity is a major concern among patients with bladder cancer. Younger patients were more likely to experience financial toxicity. Those who endorsed financial toxicity experienced delays in care and poorer health related quality of life, suggesting that treatment costs should have an important role in medical decision making.
目的
膀胱癌昂贵的监测和治疗可能导致经济毒性，即与治疗相关的经济负担。我们的目的是确定膀胱癌患者经济毒性的发生率，并确定治疗延迟及其对健康相关生活质量的影响。
材料和方法
我们在北卡罗来纳大学健康登记处/癌症生存者队列中确定了膀胱癌患者。经济毒性的定义是同意“为医疗保健支付的费用超过了您的负担能力”。使用通用和癌症特异性验证问卷来衡量健康相关的生活质量。使用 Fisher 精确检验和学生 t 检验进行统计分析。
结果
共评估了 138 例膀胱癌患者。中位年龄为 66.9 岁，75%的患者为男性，89%为白人。参与者中有 33 人（24%）表示存在经济毒性。年龄较小（p = 0.02）、黑人（p = 0.01）、报告受教育程度低于大学（p = 0.01）和患有非浸润性疾病（p = 0.04）的患者更有可能报告经济毒性。多变量分析仅年龄是经济毒性的重要预测因素。报告经济毒性的患者更有可能因无法请假或负担一般费用而延迟治疗（39%比 23%，p = 0.07）。在一般健康相关生活质量问卷中，有经济毒性的患者报告身体和心理健康状况较差（p = 0.03 和<0.01），癌症特异性健康相关生活质量（p = 0.01）、身体状况（p = 0.01）和功能状况（p = 0.05）较差。
结论
经济毒性是膀胱癌患者的一个主要问题。年轻患者更有可能经历经济毒性。那些报告经济毒性的患者经历了治疗延迟和较差的健康相关生活质量，这表明治疗费用应该在医疗决策中发挥重要作用。
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