Yap Shee-Ling, Wong Shirly Siew-Ling, Chew Keng-Sheng, Kueh Jerome Swee-Hui, Siew Ke-Lin
Faculty of Economics and Business, Universiti Malaysia Sarawak, Kota Samarahan, Sarawak, Malaysia.
Faculty of Medicine and Health Sciences, Universiti Malaysia Sarawak, Kota Samarahan, Sarawak, Malaysia.
Asian Pac J Cancer Prev. 2020 Oct 1;21(10):3077-3083. doi: 10.31557/APJCP.2020.21.10.3077.
Patient's financial ability is always the most critical imputes to treatment choice and adherence; as it translates into health outcomes such as survival rate and quality of life. Cancer care is likely to affect the patient's financial well-being, putting huge financial pressure to the families. Therefore, it is imperative to understand the confounding factors of financial toxicity among cancer survivors along the course of survivorship.
This study was designed in the form of cross-sectional analysis, in which, cancer survivors were recruited from the Sarawak General Hospital, the largest tertiary and referral public hospital in Sarawak. To capture the financial toxicity of the cancer survivors, the Comprehensive Score for Financial Toxicity (COST) instrument in its validated form was adopted. Multivariable logistic regression analysis was applied to determine the relationship between financial toxicity (FT) and its predictors.
The median age of the 461 cancer survivors was 56 while the median score of COST was 22.0. Besides, finding from multivariable logistic regression revealed that low income households (OR: 6.893, 95% CI, 3.109-15.281) were susceptible to higher risk of financial toxicity, while elderly survivors above 50 years old reported a lower risk in financial toxicity. Also, survivors with secondary schooling (OR:0.240; 95%CI, 0.110-0.519) and above [College or university (OR: 0.242; 95% CI, 0.090-0.646)] suffer a lower risk of FT.
Financial toxicity was found to be associated with survivors age, household income and educational level. In the context of cancer treatment within public health facility, younger survivors, households from B40 group and individual with educational attainment below the first level schooling in the Malaysian system of education are prone to greater financial toxicity. Therefore, it is crucial for healthcare policymakers and clinicians to deliberate the plausible risk of financial toxicity borne by the patient amidst the treatment process.
患者的经济能力始终是影响治疗选择和依从性的最关键因素；因为它会转化为诸如生存率和生活质量等健康结果。癌症护理可能会影响患者的经济状况，给家庭带来巨大的经济压力。因此，了解癌症幸存者在生存过程中发生经济毒性的混杂因素至关重要。
本研究采用横断面分析的形式进行设计，从砂拉越最大的三级转诊公立医院砂拉越总医院招募癌症幸存者。为了评估癌症幸存者的经济毒性，采用了经过验证的综合经济毒性评分（COST）工具。应用多变量逻辑回归分析来确定经济毒性（FT）与其预测因素之间的关系。
461名癌症幸存者的中位年龄为56岁，COST的中位评分为22.0。此外，多变量逻辑回归分析结果显示，低收入家庭（OR：6.893，95%CI，3.109 - 15.281）更容易面临较高的经济毒性风险，而50岁以上的老年幸存者报告的经济毒性风险较低。此外，接受过中等教育（OR：0.240；95%CI，0.110 - 0.519）及以上[大专或大学学历（OR：0.242；95%CI，0.090 - 0.646）]的幸存者遭受经济毒性的风险较低。
发现经济毒性与幸存者的年龄、家庭收入和教育水平有关。在公共卫生机构进行癌症治疗的背景下，年轻的幸存者、B40群体家庭以及马来西亚教育体系中受教育程度低于小学一年级的个体更容易面临更大的经济毒性。因此，医疗保健政策制定者和临床医生在治疗过程中考虑患者可能承受的经济毒性风险至关重要。
