Division of Surgical Oncology, Department of Surgery, University of Minnesota, Minneapolis, MN.
Department of Information Sciences, City of Hope National Medical Center, Duarte, CA.
Surgery. 2020 Jul;168(1):167-172. doi: 10.1016/j.surg.2020.02.006. Epub 2020 Mar 18.
Biopsychosocial distress screening is a critical component of comprehensive cancer care. Financial issues are a common source of distress in this patient population. This study uses a biopsychosocial distress screening tool to determine the factors associated with financial toxicity and the impact of these stressors on gastrointestinal cancer patients.
A 48-question, proprietary distress screening tool was administered to patients with gastrointestinal malignancies from 2009 to 2015. This validated, electronically-administered tool is given to all new patients. Responses were recorded on a 5-point Likert scale from 1 (not a problem) to 5 (very severe problem), with responses rated at ≥3 indicative of distress. Univariate and multivariate logistic regressions were used to analyze the data.
Most of the 1,027 patients had colorectal (50%) or hepatobiliary (31%) malignancies. Additionally, 34% of all patients expressed a high level of financial toxicity. Age greater than 65 (odds ratio: 0.63, 95% confidence interval: 0.47-0.86, P < .01), college education (odds ratio: 0.53, 95% confidence interval: 0.38-0.73, P < .0001), being partnered (odds ratio: 0.61, 95% confidence interval: 0.44-0.84, P < .01), and annual income greater than $40,000 (odds ratio: 0.27, 95% confidence interval: 0.19-0.38, P < .0001) were all protective against financial toxicity on univariate analysis. Also, heavy tobacco use was associated significantly with increased distress on univariate analysis (odds ratio: 2.79, 95% confidence interval: 1.38-5.78, P < .01). With the exception of partnered status (odds ratio: 1.18, 95% confidence interval: 0.76-1.85, P = .46), all these variables retained their significant association with financial toxicity in the multivariate model.
Financial toxicity impacts a large number of cancer patients. Further study of at-risk populations may identify patients who would benefit from pre-emptive education and counseling interventions as part of their routine cancer care.
生物心理社会困扰筛查是综合癌症护理的重要组成部分。经济问题是该患者群体中常见的困扰源。本研究使用生物心理社会困扰筛查工具来确定与财务毒性相关的因素，并评估这些压力源对胃肠道癌症患者的影响。
从 2009 年至 2015 年，对患有胃肠道恶性肿瘤的患者使用了 48 个问题的专有的困扰筛查工具。这个经过验证的电子管理工具适用于所有新患者。患者使用 5 分制（1 表示“没问题”，5 表示“非常严重的问题”）进行作答，得分≥3 表示有困扰。使用单变量和多变量逻辑回归分析数据。
1027 名患者中，大多数患有结直肠癌（50%）或肝胆癌（31%）。此外，34%的患者表示存在较高水平的财务毒性。与年龄大于 65 岁的患者（比值比：0.63，95%置信区间：0.47-0.86，P<.01）、受过大学教育（比值比：0.53，95%置信区间：0.38-0.73，P<.0001）、有伴侣（比值比：0.61，95%置信区间：0.44-0.84，P<.01）和年收入大于 40,000 美元（比值比：0.27，95%置信区间：0.19-0.38，P<.0001）的患者相比，他们在财务毒性方面的风险较低。此外，在单变量分析中，大量吸烟与困扰显著相关（比值比：2.79，95%置信区间：1.38-5.78，P<.01）。除了有伴侣（比值比：1.18，95%置信区间：0.76-1.85，P=0.46）之外，这些变量在多变量模型中均与财务毒性显著相关。
财务毒性影响了大量癌症患者。进一步研究高危人群可能会发现，某些患者可能受益于预防性教育和咨询干预，这些干预措施可作为常规癌症护理的一部分。
