Department of Radiation Oncology, University of Louisville Hospital, Louisville, Kentucky; Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, Alabama.
Department of Radiation Oncology, Medical University of South Carolina, Charleston, South Carolina; Department of Bioinformatics and Biostatistics, University of Louisville, Louisville, Kentucky.
Pract Radiat Oncol. 2022 Mar-Apr;12(2):e79-e89. doi: 10.1016/j.prro.2021.11.003. Epub 2021 Dec 9.
We sought to quantify financial toxicity (FT) present in a prospective cohort of women with breast cancer (BC) receiving radiation therapy (RT), identify predictors of FT, correlate FT with health-related quality of life (QoL), and determine whether duration of RT is associated with FT.
Consecutive patients with stage I-III BC completed Functional Assessment of Cancer Therapy-G7 (FACT-G7), a tailored FT questionnaire, and Comprehensive Score for Financial Toxicity (COST) scoring within 1 month of RT completion. Lower scores on FACT-G7 (range, 0-28) and COST (range, 0-44) indicate worse QoL and FT. Group comparisons were performed with a 2-sample t test and χ tests for continuous and categorical variables, respectively. Pearson correlation was used to associate COST with FACT-G7. Linear and multiple regression were used to evaluate predictors of COST.
One hundred eight enrolled patients were eligible for analysis with completed COST scores, including 56, 42, and 10 patients treated with long-, intermediate-, and short-course RT. Mean COST score was 28.6 and mean FACT-G7 was 18.4. Among patients treated with intermediate- and long-course RT (n = 98), marital status (higher COST associated with married status relative to other), medication cost (higher COST for no significant medication costs relative to significant medication costs), employment type (lower COST associated with disabled status or unemployed, higher COST with retired status relative to working), and surgery type (higher COST for lumpectomy relative to mastectomy) were significantly associated with COST score by multivariable analysis (all P values < .05). RT length group was not associated with COST (P = .79). COST and FACT-G7 were strongly correlated for the overall cohort (P < .0001).
In this prospective study of women with BC receiving RT, distinct factors including surgery type were significantly associated with FT. FT was strongly correlated with health-related QoL. Increased characterization of the relationship between FT and health-related QoL for women with BC receiving RT and defining clinical predictors of FT may help guide future studies investigating optimal targeted interventions for patients with BC at high risk for FT.
我们旨在量化接受放射治疗（RT）的乳腺癌（BC）女性前瞻性队列中存在的财务毒性（FT），确定 FT 的预测因素，将 FT 与健康相关的生活质量（QoL）相关联，并确定 RT 的持续时间是否与 FT 相关。
连续的 I-III 期 BC 患者在 RT 完成后 1 个月内完成了功能评估癌症治疗-G7（FACT-G7）、量身定制的 FT 问卷和综合财务毒性评分（COST）。FACT-G7（范围 0-28）和 COST（范围 0-44）评分越低，表明 QoL 和 FT 越差。通过两样本 t 检验和卡方检验分别对连续和分类变量进行组间比较。使用 Pearson 相关来关联 COST 和 FACT-G7。使用线性和多元回归来评估 COST 的预测因素。
108 名入组患者的 COST 评分完成且符合条件，包括接受长程、中程和短程 RT 的 56、42 和 10 名患者。平均 COST 评分 28.6，平均 FACT-G7 评分 18.4。在接受中程和长程 RT（n=98）的患者中，婚姻状况（已婚状态的 COST 更高，而其他状态的 COST 更低）、药物费用（无显著药物费用的 COST 更高，而有显著药物费用的 COST 更低）、就业类型（残疾或失业状态的 COST 更低，退休状态的 COST 更高，而工作状态的 COST 更低）和手术类型（保乳术的 COST 更高，而乳房切除术的 COST 更低）通过多变量分析显著与 COST 评分相关（所有 P 值均<.05）。RT 长度组与 COST 无关（P=0.79）。对于整个队列，COST 和 FACT-G7 相关性很强（P<.0001）。
在这项接受 RT 的 BC 女性的前瞻性研究中，包括手术类型在内的不同因素与 FT 显著相关。FT 与健康相关的 QoL 密切相关。更好地描述接受 RT 的 BC 女性 FT 与健康相关的 QoL 之间的关系，并确定 FT 的临床预测因素，可能有助于指导未来针对高 FT 风险的 BC 患者的最佳靶向干预措施的研究。
