Smith Grace L, Shih Ya-Chen Tina, Frank Steven J
Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Int J Part Ther. 2021 Jun 25;8(1):366-373. doi: 10.14338/IJPT-20-00054.1. eCollection 2021 Summer.
Cancer-related financial toxicity impacts head and neck cancer patients and survivors. With increasing use of proton therapy as a curative treatment for head and neck cancer, the multifaceted financial and economic implications of proton therapy-dimensions of "financial toxicity"-need to be addressed. Herein, we identify knowledge gaps and potential solutions related to the problem of financial toxicity. To date, while cost-effectiveness analysis has been used to assess the value of proton therapy for head and neck cancer, it may not fully incorporate empiric comparisons of patients' and survivors' lost productivity and disability after treatment. A cost-of-illness framework for evaluation could address this gap, thereby more comprehensively identifying the value of proton therapy and distinctly incorporating a measurable aspect of financial toxicity in evaluation. Overall, financial toxicity burdens remain understudied in head and neck cancer patients from a patient-centered perspective. Systematic, validated, and accurate measurement of financial toxicity in patients receiving proton therapy is needed, especially relative to conventional photon-based strategies. This will enrich the evidence base for optimal selection and rationale for payer coverage of available treatment options for head and neck cancer patients. In the setting of cancer care delivery, a combination of conducting proactive screening for financial toxicity in patients selected for proton therapy, initiating early financial navigation in vulnerable patients, engaging stakeholders, improving oncology provider team cost communication, expanding policies to promote price transparency, and expanding insurance coverage for proton therapy are critical practices to mitigate financial toxicity in head and neck cancer patients.
癌症相关的经济毒性影响头颈部癌症患者及其幸存者。随着质子治疗作为头颈部癌症根治性治疗方法的使用日益增加,质子治疗多方面的财务和经济影响——即“经济毒性”的维度——需要得到解决。在此,我们确定了与经济毒性问题相关的知识空白和潜在解决方案。迄今为止,虽然成本效益分析已被用于评估质子治疗对头颈部癌症的价值,但它可能没有充分纳入对患者及其幸存者治疗后生产力损失和残疾情况的实证比较。一个用于评估的疾病成本框架可以弥补这一差距,从而更全面地确定质子治疗的价值,并在评估中明确纳入经济毒性的一个可衡量方面。总体而言,从以患者为中心的角度来看,头颈部癌症患者的经济毒性负担仍未得到充分研究。需要对接受质子治疗的患者进行系统、有效且准确的经济毒性测量,尤其是相对于传统的基于光子的治疗策略。这将丰富证据基础,为头颈部癌症患者选择最佳治疗方案及支付方提供保险覆盖范围提供合理依据。在癌症护理提供过程中,对选择接受质子治疗的患者进行经济毒性的主动筛查、对脆弱患者尽早开展财务指导、让利益相关者参与进来、改善肿瘤医疗团队的成本沟通、扩大促进价格透明度的政策以及扩大质子治疗的保险覆盖范围,这些措施相结合是减轻头颈部癌症患者经济毒性的关键做法。