Department of Breast Surgery, Shanxi Academy of Medical Sciences, The Affiliated Shanxi Bethune Hospital of Shanxi Medical University, Taiyuan, 030032, Shanxi, China.
Cancer Research Institute, University of South Australia, Adelaide, 5000, Australia.
Breast Cancer Res Treat. 2020 Jun;181(2):435-443. doi: 10.1007/s10549-020-05632-3. Epub 2020 Apr 18.
To assess the financial toxicity (FT) and to investigate patients and cancer characteristic that associated with it in patients admitted in a tertiary hospital in central China.
This was a cross-sectional study of 166 patients from 188 with stage 0-III women breast cancer admitted in Bethune hospital in Taiyuan, Shanxi province during January-May 2019. FT was self-reported using of financial Toxicity Comprehensive Rating Scale (COST-FACIT). Patients' sociodemographic factors, clinical examination, and cancer treatment were collected from questionnaire and hospital record. The financial concern and coping strategy was self-reported. Factors associated with FT were identified using linear regression analysis.
Of the 166 completed the survey, the COST score ranged 0-40 with a mean of 21.2 (median 22.5, standard deviation 8.1). On multivariate linear regression analysis, older age (β coefficient: 0.20, 95% CI 0.11-0.29, p < 0.001), higher household income (β coefficient: 3000-5000 Yuan: 7.88, 95% CI 4.74-11.01, p < 0.001; ≥ 5000 Yuan: 12.81, 95% CI 9.54-16.08, p < 0.001) were positively associated with COST scores. Advanced cancer stage was the strongest predictor of FT among the cancer characteristics (β coefficient: - 4.52, 95% CI - 7.13-1.92, p = 0.001). To cope with the FT, 131 (78.8%) patients decreased non-medical expenses, and 56 (33.7%) reduced or quitted treatment.
FT was significantly associated with patient's age, income, and cancer stage. Women having financial concerns after diagnosis were more likely to reduce their non-medical expenses and even quit treatments. Clinicians should take into account the FT levels in all patients and work out appropriate treatment strategies for optimal clinical outcome.
评估在中国中部一家三级医院住院的患者的财务毒性（FT），并调查与财务毒性相关的患者和癌症特征。
这是一项横断面研究，共纳入 188 名 0-III 期女性乳腺癌患者，于 2019 年 1 月至 5 月在山西省太原市的白求恩医院住院。采用财务毒性综合评价量表（COST-FACIT）对 FT 进行自报评估。从问卷和医院记录中收集患者的社会人口统计学因素、临床检查和癌症治疗情况。自报财务担忧和应对策略。采用线性回归分析确定与 FT 相关的因素。
在完成调查的 166 名患者中，COST 评分范围为 0-40，平均 21.2（中位数 22.5，标准差 8.1）。多变量线性回归分析显示，年龄较大（β系数：0.20，95%CI 0.11-0.29，p<0.001）、家庭收入较高（β系数：3000-5000 元：7.88，95%CI 4.74-11.01，p<0.001；≥5000 元：12.81，95%CI 9.54-16.08，p<0.001）与 COST 评分呈正相关。癌症特征中，晚期癌症是 FT 的最强预测因素（β系数：-4.52，95%CI -7.13-1.92，p=0.001）。为应对 FT，131 名（78.8%）患者减少了非医疗支出，56 名（33.7%）患者减少或停止了治疗。
FT 与患者年龄、收入和癌症分期显著相关。诊断后有财务担忧的女性更有可能减少非医疗支出，甚至停止治疗。临床医生应考虑所有患者的 FT 水平，并制定出适当的治疗策略，以获得最佳的临床效果。
