Paul C. Nathan, The Hospital for Sick Children, Toronto, Ontario, Canada; Tara O. Henderson, The University of Chicago, Chicago, IL; Anne C. Kirchhoff, University of Utah, Salt Lake City, UT; Elyse R. Park, Massachusetts General Hospital, Boston, MA; and K. Robin Yabroff, American Cancer Society, Atlanta, GA.
J Clin Oncol. 2018 Jul 20;36(21):2198-2205. doi: 10.1200/JCO.2017.76.4431. Epub 2018 Jun 6.
In addition to the long-term physical and psychological sequelae of cancer therapy, adult survivors of childhood cancer are at an elevated risk for financial hardship. Financial hardship can have material, psychological, and behavioral effects, including high out-of-pocket medical costs, asset depletion and debt, limitations in or inability to work, job lock, elevated stress and worry, and a delaying or forgoing of medical care because of cost. Most financial hardship research has been conducted in survivors of adult cancers. The few studies focused on childhood cancer survivors have shown that these individuals are at elevated risk for having difficulties with affording needed health care and report high out-of-pocket medical expenses, difficulty with paying medical bills, or consideration of filing for bankruptcy. Childhood cancer survivors are more likely to be unable to work or to have missed work because of poor health. They are more likely to report difficulties with obtaining insurance coverage and rely more frequently on government-sponsored insurance. Globally, countries able to provide curative cancer therapies have witnessed a growing population of survivors, which places a burden on their health care systems because survivors are more likely to require hospitalization and experience a higher burden of chronic illness than the general population. Guidelines for surveillance for late effects are intended to reduce the burden of morbidity, but research is needed to determine whether such surveillance is cost effective. Of note, risk-based survivor care should include routine surveillance for financial hardship. Improved measures of financial hardship, enhanced data infrastructure, and research studies to identify survivors and families most vulnerable to financial hardship and adverse health outcomes will inform the development of targeted programs to serve as a safety net for those at greatest risk.
除了癌症治疗带来的长期身体和心理后遗症外，儿童癌症成年幸存者还面临着经济困难的高风险。经济困难会产生物质、心理和行为方面的影响，包括高昂的自付医疗费用、资产耗尽和债务、工作受限或无法工作、工作锁定、压力和焦虑增加，以及因费用而延迟或放弃医疗护理。大多数关于经济困难的研究都是在成年癌症幸存者中进行的。少数针对儿童癌症幸存者的研究表明，这些人在负担必要的医疗保健方面存在困难，报告自付医疗费用高、支付医疗费用困难或考虑申请破产。儿童癌症幸存者更有可能无法工作或因健康状况不佳而旷工。他们更有可能报告在获得保险覆盖方面存在困难，并且更频繁地依赖政府赞助的保险。在全球范围内，能够提供癌症治疗的国家见证了幸存者人数的增长，这给他们的医疗保健系统带来了负担，因为幸存者比一般人群更有可能需要住院治疗，并承受更高的慢性病负担。晚期影响监测指南旨在减轻发病率负担，但需要研究来确定这种监测是否具有成本效益。值得注意的是，基于风险的幸存者护理应包括对经济困难的常规监测。需要改进经济困难的衡量标准，增强数据基础设施，并进行研究以确定最容易受到经济困难和不良健康结果影响的幸存者和家庭，这将为制定针对高危人群的目标计划提供信息，作为他们的安全网。
