Division of Hematology and Medical Oncology, Department of Medicine, Mayo Clinic Arizona, Phoenix, Arizona.
Blood and Marrow Transplantation, Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio.
Biol Blood Marrow Transplant. 2019 Mar;25(3):599-605. doi: 10.1016/j.bbmt.2018.09.040. Epub 2018 Oct 5.
Understanding the socioeconomic impact of chronic graft-versus-host disease (GVHD) on affected patients is essential to help improve their overall well-being. Using data from the Chronic GVHD Consortium, we describe the insurance, employment, and financial challenges faced by these patients and the factors associated with the ability to work/attend school and associated financial burdens. A 15-item cross-sectional questionnaire designed to measure financial concerns, income, employment, and insurance was completed by 190 patients (response rate, 68%; 10 centers) enrolled on a multicenter Chronic GVHD Consortium Response Measures Validation Study. Multivariable logistic regression models examined the factors associated with financial burden and ability to work/attend school. The median age of respondents was 56years, and 87% of the patients were white. A higher proportion of nonrespondents had lower income before hematopoietic cell transplantation and less than a college degree. All but 1 patient had insurance, 34% had faced delayed/denied insurance coverage for chronic GVHD treatments, and 66% reported a financial burden. Patients with a financial burden had greater depression/anxiety and difficulty sleeping. Nonwhite race, lower mental functioning, and lower activity score were associated with a greater likelihood of financial burden. Younger age, early risk disease, and higher mental functioning were associated with a greater likelihood of being able to work/attend school. In this multicenter cohort of patients with chronic GVHD, significant negative effects on finances were observed even with health insurance coverage. Future research should investigate potential interventions to provide optimal and affordable care to at-risk patients and prevent long-term adverse financial outcomes in this vulnerable group.
了解慢性移植物抗宿主病（cGVHD）对受影响患者的社会经济影响对于改善其整体福祉至关重要。利用慢性移植物抗宿主病联盟的数据，我们描述了这些患者面临的保险、就业和财务挑战，以及与工作/上学能力和相关财务负担相关的因素。一项针对财务问题、收入、就业和保险的 15 项横断面问卷由 190 名患者（响应率为 68%；10 个中心）完成，他们参加了多中心慢性移植物抗宿主病联盟反应措施验证研究。多变量逻辑回归模型检查了与财务负担和工作/上学能力相关的因素。受访者的中位年龄为 56 岁，87%的患者为白人。未应答者中，造血细胞移植前收入较低和未获得大学学位的比例较高。除 1 例患者外，所有患者均有保险，34%的患者因慢性移植物抗宿主病治疗而面临保险延迟/拒绝，66%的患者报告存在财务负担。有财务负担的患者抑郁/焦虑和睡眠困难更为严重。非白种人、较低的精神功能和较低的活动评分与更大的财务负担可能性相关。年龄较小、早期高危疾病和较高的精神功能与更有可能工作/上学相关。在这项多中心慢性移植物抗宿主病患者队列中，即使有医疗保险，仍观察到对财务状况的重大负面影响。未来的研究应调查潜在的干预措施，为高危患者提供最佳和负担得起的护理，并防止这一脆弱群体的长期不良财务后果。
