Department of Behavioral Science, Markey Cancer Center, Center for Health Equity Transformation, University of Kentucky College of Medicine, Lexington, KY.
Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC.
JCO Oncol Pract. 2021 Aug;17(8):e1110-e1119. doi: 10.1200/OP.20.00723. Epub 2021 Feb 4.
Immunotherapy or chemoimmunotherapy is now standard treatment for most patients with metastatic non-small-cell lung cancer (mNSCLC), yet patient supportive care needs (SCNs) on immunotherapy are not well defined. This study characterized the SCNs and financial hardship of patients with mNSCLC treated with immunotherapy or chemoimmunotherapy and examined the relationship between patient and caregiver cancer-related employment reductions and patient financial hardship.
Patients with mNSCLC on immunotherapy or chemoimmunotherapy from a single academic medical center completed the SCNs Survey-34, items indexing material, psychological, and behavioral financial hardship, and the Comprehensive Score for Financial Toxicity. Univariate and bivariate analyses examined care needs, financial hardship, and impact of cancer-related employment reductions on patient financial hardship.
Sixty patients (40% male; 75% White, mean age = 62.5 years, 57% on immunotherapy alone) participated. Fifty-five percent reported unmet needs in physical or daily living and psychological domains. Financial hardship was common (33% material, 63% psychological, and 57% behavioral). Fifty-two percent reported hardship in at least two domains. Forty percent reported a caregiver cancer-related employment reduction. Caregiver employment reduction was related to patient financial hardship (68% of those reporting caregiver employment reduction reported at least two domains of hardship 40% of those without reduction, = .03) and patient financial distress (mean Comprehensive Score for Financial Toxicity = 19.6 among those with caregiver employment reduction 26.8 without, = .01).
Patients with mNSCLC treated with immunotherapy or chemoimmunotherapy report multiple unmet care needs and financial hardship. Psychological, functional, financial, and caregiver concerns merit assessment and intervention in this population.
免疫治疗或化疗免疫治疗现已成为大多数转移性非小细胞肺癌（mNSCLC）患者的标准治疗方法，但免疫治疗患者的支持性护理需求（SCN）尚未得到很好的定义。本研究描述了接受免疫治疗或化疗免疫治疗的 mNSCLC 患者的 SCN 和经济困难情况，并探讨了患者和护理人员癌症相关就业减少与患者经济困难之间的关系。
来自单一学术医疗中心的接受免疫治疗或化疗免疫治疗的 mNSCLC 患者完成了 SCNs 调查-34，该调查包括物质、心理和行为财务困难以及全面财务毒性评分的指标项目。单变量和双变量分析检查了护理需求、经济困难以及癌症相关就业减少对患者经济困难的影响。
共有 60 名患者（40%为男性；75%为白人，平均年龄为 62.5 岁，57%单独接受免疫治疗）参与了研究。55%的患者报告在身体或日常生活以及心理方面存在未满足的需求。经济困难很常见（33%为物质困难，63%为心理困难，57%为行为困难）。52%的患者报告至少有两个领域存在困难。40%的患者报告护理人员癌症相关就业减少。护理人员就业减少与患者经济困难相关（报告护理人员就业减少的患者中有 68%报告至少有两个领域的困难，而没有减少的患者中为 40%， =.03），与患者财务困境相关（报告有护理人员就业减少的患者的全面财务毒性评分平均值为 19.6，而没有减少的患者为 26.8， =.01）。
接受免疫治疗或化疗免疫治疗的 mNSCLC 患者报告存在多种未满足的护理需求和经济困难。在这一人群中，应评估和干预心理、功能、财务和护理人员的问题。
