癌症治疗的财务毒性：三个不同医疗体系下的财务负担分析。
Financial Toxicity of Cancer Care: An Analysis of Financial Burden in Three Distinct Health Care Systems.
机构信息
Department of Medicine, Stanford University, Stanford, CA.
Department of Health Research and Policy, Stanford University, Stanford, CA.
出版信息
JCO Oncol Pract. 2021 Oct;17(10):e1450-e1459. doi: 10.1200/OP.20.00890. Epub 2021 Apr 7.
PURPOSE
The financial toxicity of cancer care is a source of significant distress for patients with cancer. The purpose of this study is to understand factors associated with financial toxicity in three distinct care systems.
METHODS
We conducted a cross-sectional survey of patients in three care systems, Stanford Cancer Institute (SCI), VA Palo Alto Health Care System (VAPAHCS), and Santa Clara Valley Medical Center (SCVMC), from October 2017 to May 2019. We assessed demographic factors, employment status, and out-of-pocket costs (OOPCs) and administered the validated COmprehensive Score for financial Toxicity tool. We calculated descriptive statistics and conducted linear regression models to analyze factors associated with financial toxicity.
RESULTS
Four hundred forty-four of 578 patients (77%) completed the entire COmprehensive Score for financial Toxicity tool and were included in the analysis. Most respondents at SCI were White, with annual household income (AHI) > $50,000 USD and Medicare insurance. At the VAPAHCS, most were White, with AHI ≤ $50,000 USD and insured by the Veterans Administration. At SCVMC, most were Asian and/or Pacific Islander, with AHI ≤ $25,000 USD and Medicaid insurance. Low AHI ( < .0001), high OOPCs ( = .003), and employment changes as a result of cancer diagnosis ( < .0001) were associated with financial toxicity in the pooled analysis. There was variation in factors associated with financial toxicity by site, with employment changes significant at SCI, OOPCs at SCVMC, and no significant factors at the VAPAHCS.
CONCLUSION
Low AHI, high OOPCs, and employment changes contribute to financial toxicity; however, there are variations based on site of care. Future studies should tailor financial toxicity interventions within care delivery systems.
目的
癌症治疗的财务毒性是癌症患者产生巨大痛苦的一个根源。本研究旨在了解三种不同医疗体系中与财务毒性相关的因素。
方法
我们于 2017 年 10 月至 2019 年 5 月，在斯坦福癌症研究所（SCI）、退伍军人事务部帕洛阿尔托卫生保健系统（VAPAHCS）和圣克拉拉谷医疗中心（SCVMC）这三个医疗体系中，对患者进行了横断面调查。我们评估了人口统计学因素、就业状况和自付费用（OOPCs），并使用经过验证的财务毒性综合评分工具（COmprehensive Score for financial Toxicity tool）进行评估。我们计算了描述性统计数据，并进行了线性回归模型分析，以分析与财务毒性相关的因素。
结果
在 578 名患者中，有 444 名（77%）完成了整个财务毒性综合评分工具的填写，被纳入分析。在 SCI，大多数受访者为白人，年收入（AHI）超过 50000 美元，有医疗保险。在 VAPAHCS，大多数受访者为白人，年收入在 50000 美元以下，有退伍军人事务部保险。在 SCVMC，大多数受访者为亚裔和/或太平洋岛民，年收入在 25000 美元以下，有医疗补助保险。低 AHI（<.0001）、高 OOPCs（=.003）和因癌症诊断而导致的就业变化（<.0001）与汇总分析中的财务毒性相关。基于医疗地点，与财务毒性相关的因素存在差异，在 SCI 中，就业变化显著，在 SCVMC 中，OOPCs 显著，而在 VAPAHCS 中，没有显著因素。
结论
低 AHI、高 OOPCs 和就业变化导致了财务毒性；然而，基于医疗地点，存在着变化。未来的研究应该根据医疗提供系统，调整财务毒性干预措施。
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