Department of Medicine, Oregon Health and Science University Hospital, Portland.
Division of Hematology/Oncology, James P Wilmot Cancer Institute, University of Rochester School of Medicine and Dentistry, Rochester, New York.
JAMA Netw Open. 2020 Dec 1;3(12):e2025810. doi: 10.1001/jamanetworkopen.2020.25810.
Financial toxicity (FT), unintended and unanticipated financial burden experienced by cancer patients undergoing cancer care, is associated with negative consequences and increased risk of mortality. Older patients (≥70 years) with cancer are at risk for FT, yet data are limited on FT and whether oncologists discuss FT with their patients.
To examine the prevalence of FT in older adults with advanced cancer, its association with health-related quality of life (HRQoL), and cost conversations between oncologists and patients.
DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional secondary analysis was performed on baseline data from the Improving Communication in Older Cancer Patients and Their Caregivers study, a cluster randomized trial from 31 community oncology practices across the US that was conducted from October 29, 2014, to April 28, 2017. Participants included 536 patients with advanced cancer who answered 3 questions regarding financial toxicity. Data were analyzed from September 1, 2019, to May 1, 2020.
Older patients undergoing cancer care treatments.
The main outcome looked at FT and its association with HRQoL. Three questions were used to identify patients 70 years or older experiencing FT. Multivariable linear regression models were used to assess the independent associations of FT with HRQoL. A single audio-recorded clinic transcript was analyzed within 4 weeks of enrollment for patients with FT. The framework method was used to identify frequency and themes related to cost conversations.
This study evaluated 536 patients 70 years or older with advanced cancer. Ninety-eight patients (18.3%) reported FT; mean (SD) age was 76.4 (5.4) years; 59 (60.2%) were female, 14 (14.3%) were Black/African American, 91 (92.9%) were not employed, and 29 (29.6%) had Medicare as their sole insurance coverage. On multivariate regression analyses, FT was associated with higher levels of depression (β = 0.81; 95% CI, 0.15-1.48), anxiety (β = 1.67; 95% CI, 0.74-2.61), and distress (β = 0.73; 95% CI, 0.08-1.39) and lower HRQoL (β = -5.30; 95% CI, -8.92 to -1.69). Among those who reported FT, 49% had a conversation with their health care professional about costs. Most conversations (79%) were initiated by oncologists or patients. Four themes were generated from cost conversations: statements regarding cost of care, ability to afford medical prescriptions, indirect consequences associated with inability to work and provide for family, and cost burden in nontreatment domains.
In this study, among older adults with advanced cancer, FT is associated with worse HRQoL. Almost half of conversations among patients reporting FT demonstrated costs are being actively discussed. Resources and interventions are needed to manage FT.
癌症患者在接受癌症治疗过程中所经历的意外和意料之外的财务负担，即财务毒性（FT），与负面后果和死亡率增加有关。患有癌症的老年患者（≥70 岁）有患 FT 的风险，但关于 FT 以及肿瘤学家是否与患者讨论 FT 的数据有限。
研究老年晚期癌症患者中 FT 的患病率、它与健康相关生活质量（HRQoL）的关系，以及肿瘤学家与患者之间的成本对话。
设计、地点和参与者：这是一项在美国 31 个社区肿瘤学实践中的一项聚类随机试验——改善老年癌症患者及其护理人员沟通研究中的基线数据的二次分析，该试验从 2014 年 10 月 29 日至 2017 年 4 月 28 日进行。参与者包括 536 名患有晚期癌症的患者，他们回答了 3 个关于财务毒性的问题。数据于 2019 年 9 月 1 日至 2020 年 5 月 1 日进行分析。
正在接受癌症治疗的老年患者。
主要结果是 FT 及其与 HRQoL 的关系。用三个问题来确定 70 岁或以上的经历 FT 的患者。多变量线性回归模型用于评估 FT 与 HRQoL 的独立相关性。对于有 FT 的患者，在入组后 4 周内对其进行了一次单独的音频记录临床转录分析。采用框架方法识别与成本对话相关的频率和主题。
这项研究评估了 536 名 70 岁或以上患有晚期癌症的患者。98 名患者（18.3%）报告了 FT；平均（SD）年龄为 76.4（5.4）岁；59 名（60.2%）为女性，14 名（14.3%）为黑人/非裔美国人，91 名（92.9%）未就业，29 名（29.6%）仅以医疗保险为保险。在多变量回归分析中，FT 与更高水平的抑郁（β=0.81；95%CI，0.15-1.48）、焦虑（β=1.67；95%CI，0.74-2.61）和困扰（β=0.73；95%CI，0.08-1.39）以及较低的 HRQoL（β=-5.30；95%CI，-8.92 至-1.69）相关。在报告 FT 的患者中，有 49%的人与他们的医疗保健专业人员讨论了费用问题。大多数对话（79%）是由肿瘤学家或患者发起的。从成本对话中生成了四个主题：关于护理成本的陈述、支付医疗处方的能力、无法工作和为家庭提供帮助的间接后果，以及非治疗领域的成本负担。
在这项研究中，在患有晚期癌症的老年患者中，FT 与较差的 HRQoL 相关。在报告 FT 的患者中，近一半的对话表明正在积极讨论费用。需要资源和干预措施来管理 FT。
