法国和美国晚期癌症患者的财务困境、症状和生活质量不平等
Inequalities in Financial Distress, Symptoms, and Quality of Life Among Patients with Advanced Cancer in France and the U.S.
机构信息
Department of Supportive and Palliative Care, Centre Hospitalo-Universitaire de Grenoble, La Tronche, France
Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, U.S.A.
出版信息
Oncologist. 2019 Aug;24(8):1121-1127. doi: 10.1634/theoncologist.2018-0353. Epub 2019 Mar 15.
BACKGROUND
Financial distress (FD) is common among patients with advanced cancer. Our purpose was to compare the frequency and intensity of FD and its associations with symptom distress and quality of life (QOL) in these patients in France and the U.S.
MATERIALS AND METHODS
In this secondary analysis of two cross-sectional studies, we assessed data on 292 patients who received cancer care at a public hospital or a comprehensive cancer center in France (143 patients) or the U.S. (149 patients). Outpatients and hospitalized patients over 18 years of age with advanced lung or breast or colorectal or prostate cancer were included. Diagnosed cognitive disorder was considered a noninclusion criterion. Advanced cancer included relapse or metastasis or locally advanced cancer or at least a second-line chemotherapy regimen. Patients self-rated FD and assessed symptoms, psychosocial distress, and QOL on validated questionnaires.
RESULTS
The average patient age was 59 years, and 144 (49%) were female. FD and high intensity were reported more frequently in U.S. patients than in French (respectively 129 [88%] vs. 74 [52%], < .001; 100 [98%] vs. 48 [34%], < .001,). QOL was rated higher by the U.S. patients than by the French (69 [SD, 18] vs. 63 [SD, 18], = .003). French patients had more psychological symptoms such as anxiety (8 [SD, 4] vs. 6 [SD, 5], = .008). Associations were found between FD and U.S. residence, FD and single status (0.907, = .023), and FD and metastasis (1.538, = .036). In contrast, negative associations were found between FD and older age (-0.052, = .003) and FD and France residence (-3.376, = .001).
CONCLUSION
Regardless of health care system, FD is frequent in patients with advanced cancer. U.S. patients were more likely to have FD than French patients but reported better QOL. Further research should focus on factors contributing to FD and opportunities for remediation.
IMPLICATIONS FOR PRACTICE
Suffering is experienced in any component of the lives of patients with a life-threatening illness. Financial distress (FD) is one of the least explored cancer-related symptoms, and there are limited studies describing its impact on this frail population. This study highlights the high frequency and severity of FD in patients with advanced cancer in the U.S. and France as well as its impact on their physical and emotional symptoms and their quality of life in these different health care systems. It is necessary for all health care providers to explore and evaluate the presence of FD in patients living with life-threatening illnesses.
背景
财务困境（FD）在晚期癌症患者中很常见。我们的目的是比较法国和美国这些患者中 FD 的频率和强度及其与症状困扰和生活质量（QOL）的关系。
材料和方法
在这两项横断面研究的二次分析中，我们评估了在法国一家公立医院或综合癌症中心（143 例患者）或美国（149 例患者）接受癌症治疗的 292 例患者的数据。纳入年龄在 18 岁以上、患有晚期肺癌、乳腺癌、结直肠癌或前列腺癌的门诊和住院患者。确诊的认知障碍被视为排除标准。晚期癌症包括复发、转移、局部晚期癌症或至少二线化疗方案。患者自我评估 FD，并使用经过验证的问卷评估症状、心理社会困扰和 QOL。
结果
患者平均年龄为 59 岁，144 例（49%）为女性。与法国患者相比，美国患者报告 FD 和高强度 FD 的频率更高（分别为 129 [88%]比 74 [52%]， < .001；100 [98%]比 48 [34%]， < .001）。美国患者的 QOL 评分高于法国患者（69 [标准差，18]比 63 [标准差，18]， = .003）。法国患者的焦虑等心理症状更多（8 [标准差，4]比 6 [标准差，5]， = .008）。FD 与美国居住、FD 与单身状态（0.907， = .023）和 FD 与转移（1.538， = .036）有关。相比之下，FD 与年龄较大（-0.052， = .003）和法国居住（-3.376， = .001）呈负相关。
结论
无论医疗保健系统如何，晚期癌症患者中 FD 都很常见。与法国患者相比，美国患者更有可能出现 FD，但报告的 QOL 更好。进一步的研究应侧重于导致 FD 的因素和补救机会。
意义
患有危及生命疾病的患者在其生活的各个方面都经历着痛苦。财务困境（FD）是癌症相关症状中研究最少的症状之一，关于其对这一脆弱人群的影响的研究有限。这项研究强调了在美国和法国，晚期癌症患者中 FD 的高频率和严重程度，以及它对他们身体和情绪症状以及他们在这些不同医疗保健系统中的生活质量的影响。所有医疗保健提供者都有必要探索和评估患有危及生命疾病的患者是否存在 FD。
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