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临床试验中的患者体验:与标准治疗相比,多发性骨髓瘤或淋巴瘤患者参加临床试验的生活质量、经济负担和护理认知。

Patient Experience in Clinical Trials: Quality of Life, Financial Burden, and Perception of Care in Patients With Multiple Myeloma or Lymphoma Enrolled on Clinical Trials Compared With Standard Care.

机构信息

Division of BMT and Cellular Therapy, Stanford University School of Medicine, Stanford, CA.

Division of Hematology, Mayo Clinic, Rochester, MN.

出版信息

JCO Oncol Pract. 2022 Aug;18(8):e1320-e1333. doi: 10.1200/OP.21.00789. Epub 2022 May 17.

Abstract

PURPOSE

Patients' concerns regarding clinical trial (CT) participation include apprehension about side effects, quality of life (QoL), financial burden, and quality of care.

METHODS

We prospectively evaluated the experience of patients with multiple myeloma or lymphoma who were treated on CTs (CT group, n = 35) versus patients treated with standard approaches (non-CT group, n = 88) focusing on QoL, financial burden of care, and patients' perception of quality of care over a 1-year period.

RESULTS

There were no significant differences in any of the patient-reported outcomes in CT versus non-CT groups. We observed an initial decline in overall QoL in the first 3 months across both groups, driven primarily by physical and functional well-being. QoL gradually improved and was above baseline by month 12. Patients reported highest improvement in the functional well-being subdomain. Patients in both groups reported high satisfaction with the quality of care received, and there were no differences in overall satisfaction, communication with team, or access to care. At baseline, 16%-19% of patients reported financial burden, which increased to a peak of 33% in the CT group and to 49% in the non-CT group over the course of 1 year. There was no significant difference in financial burden in the two groups overall. Most of the patients reported getting all the care that was deemed medically necessary in both groups. However, a significant proportion of patients reported having to make other kinds of financial sacrifices because of their cancer (CT group: 33% of patients at baseline and 21%-40% over 1 year; non-CT group: 19% at baseline and 25%-36% over 1 year).

CONCLUSION

Patients treated on CTs reported comparable QoL and quality of care with the non-CT group. A high proportion of patients reported financial burden over time in both groups. Our findings can serve as a guide to educate patients regarding CT participation and highlight the need to address the significant financial burden experienced by patients with cancer.

摘要

目的

患者对临床试验(CT)参与的担忧包括对副作用、生活质量(QoL)、经济负担和护理质量的担忧。

方法

我们前瞻性评估了接受 CT 治疗的多发性骨髓瘤或淋巴瘤患者(CT 组,n=35)与接受标准治疗的患者(非 CT 组,n=88)的经验,重点关注 1 年内的 QoL、护理经济负担和患者对护理质量的感知。

结果

CT 组与非 CT 组患者在任何患者报告的结果方面均无显著差异。我们观察到两组患者在最初的 3 个月内整体 QoL 下降,主要是由身体和功能健康状况驱动的。QoL 逐渐改善,在第 12 个月时高于基线。患者报告在功能健康状况亚领域的改善最大。两组患者均对所接受的护理质量表示高度满意,在总体满意度、与团队的沟通或获得护理方面无差异。在基线时,16%-19%的患者报告存在经济负担,在 CT 组中增加至峰值 33%,在非 CT 组中增加至 1 年内的 49%。两组患者的经济负担总体上无显著差异。两组患者中大多数报告获得了他们认为医疗上必需的所有护理。然而,相当一部分患者报告因癌症而不得不做出其他类型的经济牺牲(CT 组:基线时 33%的患者,1 年内为 21%-40%;非 CT 组:基线时 19%的患者,1 年内为 25%-36%)。

结论

接受 CT 治疗的患者报告的 QoL 和护理质量与非 CT 组相当。随着时间的推移,两组患者中有相当一部分患者报告存在经济负担。我们的研究结果可以作为教育患者关于 CT 参与的指南,并强调需要解决癌症患者所经历的重大经济负担。

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